Questionnaire for Patients who Suffered from Cardiac Arrest but Survived

Undetermined Cause of Cardiac Arrest during Hemodialysis — Connecticut 2015-2016

OMB: 0920-1095

IC ID: 219759

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Questionnaire for Patients who Suffered from Cardiac Arrest but Survived
 
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Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Questionnaire for Patients who Suffered Cardiac Arrest but Survived Att 3 - Case patient interview questions.docx NA No   Paper Only

Health Public Health Monitoring

09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62812

4 0
   
Individuals or Households
 
   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 4 0 4 0 0 0
Annual IC Time Burden (Hours) 2 0 2 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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