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 Attachment 96 Attachment 96 – MPC Institution Provider Questionnaire Attachment 96 – MPC Institution Provider Questionnaire.docx Yes Yes Fillable Fileable

Health Immunization Management

 

116 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 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
Attachment 93 – MPC Letters, Email Templates, and Other Documents Attachment 93 MPC Letter.docx 09/14/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.