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

View Information Collection (IC)

Institutions (non-hospital) questionnaire
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #1 Yes Yes Fillable Fileable

Health Immunization Management

 

117 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 238 0 0 0 0 238
Annual IC Time Burden (Hours) 36 0 0 0 0 36
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 88 – MPC Hospital Provider Authorization Form Package, One Point of Contact for Medical and Patient Account Records 09/14/2015
Attachment 89 – MPC Hospital Provider Authorization Form Package, Point of Contact for Medical Records 09/14/2015
Attachment 90 – MPC Hospital Provider Authorization Form Package, Point of Contact for Patient Account Records 09/14/2015
Attachment 91 – MPC Hospital Provider Overflow Patient List 09/14/2015
Attachment 93 – MPC Letters, Email Templates, and Other Documents 09/14/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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