View Information Collection (IC)

View Information Collection (IC)

Hospitals questionnaire
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Attachment 91 Attachment 91 – MPC Hospital Provider Questionnaire Attachment 91 – MPC Hospital Provider Questionnaire.docx No   Fillable Fileable

Health Immunization Management

 

5,310 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 17,311 0 0 0 0 17,311
Annual IC Time Burden (Hours) 2,597 0 0 0 0 2,597
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 Attachment 88 MPC Hospital_MRPA_AF_Packet.doc 09/14/2015
Attachment 89 – MPC Hospital Provider Authorization Form Package, Point of Contact for Medical Records Attachment 89 MPC Hospital_MR_AF_Packet.doc 09/14/2015
Attachment 90 – MPC Hospital Provider Authorization Form Package, Point of Contact for Patient Account Records Attachment 90 MPC Hospital_PA_AF_Packet.doc 09/14/2015
Attachment 91 – MPC Hospital Provider Overflow Patient List Attachment 91 MPC Hospital_Overflow_Patient_List.docx 09/14/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.