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

View Information Collection (IC)

Home Care Providers Event Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 4a Yes Yes Fillable Fileable
Form and Instruction 5a Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

886 0
   
Private Sector Businesses or other for-profits, 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 5,139 0 4,167 0 0 972
Annual IC Time Burden (Hours) 257 0 111 0 0 146
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 76 – MPC Home Care Provider Authorization Form Package, Records to be Provided via Fax Anticipated 09/11/2015
Attachment 75 – MPC Home Care Provider Authorization Form Package, Phone Data Collection Anticipated 09/11/2015
Attachment 77 – MPC Home Care Provider Overflow Patient List 09/11/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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