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

Analysis and Use of Core Data Sets 0920-0853
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0853 PM Reporting Tool MAY2023 Att5a_PMReportingTool.xlsx NA Yes Yes Fillable Fileable
Form and Instruction 0920-0853 ED Visits Reporting Form MAY2023 Att6a_AIRS ED Visits Reporting Form.xlsx NA Yes Yes Fillable Fileable
Form and Instruction 0920-0853 HD Reporting Form MAY2023 Att7a_AIRS HD Reporting Forms.xlsx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

90 0
   
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 90 0 0 0 0 90
Annual IC Time Burden (Hours) 105 0 0 0 0 105
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
PM Comparison Table Att8_PM Comparison Table.docx 05/16/2023
ED Visits Reporting Example Att6b_AIRS ED Visits Reporting Example.xlsx 05/16/2023
HD Reporting Example Att7b_AIRS HD Reporting Example.xlsx 05/16/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.