View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

8a_MMP 2018 Questionnaire (English) 0920-0740
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-0740 Yes Yes Fillable Printable
Form 0920-0222 Yes Yes Fillable Printable
Form 0920-0222 No   Paper Only

Health Public Health Monitoring

 

7,760 7,520
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 7,760 0 -960 0 0 8,720
Annual IC Time Burden (Hours) 5,820 0 -720 0 0 6,540
Annual IC Cost Burden (Dollars) 126,701 0 -15,675 0 0 142,376

Title Document Date Uploaded
11d_Model Patient Recruitment Script 05/17/2018
Att 4_ Minimum Data Element 05/17/2018
Att 13_Medical Record Abstraction Data Elements 05/17/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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