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

View Information Collection (IC)

Hospital Enrollment, Additions and Recertifcations
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1.1 Yes Yes Fillable Fileable
Form 1.2 Yes Yes Fillable Fileable
Form 1.3 Yes Yes Fillable Fileable
Form 1.4 Yes Yes Fillable Fileable
Form 1.5 Yes Yes Fillable Fileable
Form 1.6 Yes Yes Fillable Fileable
Form 1.7 Yes Yes Fillable Fileable
Form 1.8 Yes Yes Fillable Fileable
Form 1.9 Yes Yes Fillable Fileable
Form 1.10 Yes Yes Fillable Fileable
Form 1.11 Yes Yes Fillable Fileable

Health Health Care Services

 

3,394 15
   
Private Sector Not-for-profit institutions
 
   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 30,378 0 30,184 0 0 194
Annual IC Time Burden (Hours) 9,358 0 8,970 0 0 388
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Registration DSH 08/12/2019
Registration PED 08/12/2019
Registration CAN 08/12/2019
Registration Outpatient 08/12/2019
Registration SCH and RRC 08/12/2019
REDLINE Registration CAH 08/12/2019
REDLINE Recert DSH 08/12/2019
REDLINE Recert SCH and RRC 08/12/2019
REDLINE Recert PED 08/12/2019
REDLINE Recert CAH 08/12/2019
REDLINE Recert CAN 08/12/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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