Pull Medical Records

[NCHHSTP] Medical Monitoring Project

OMB: 0920-0740

IC ID: 180569

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Pull Medical Records 0920-0740
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Att 8f Facility pull medical records.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

7,760 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 7,760 0 0 0 0 7,760
Annual IC Time Burden (Hours) 388 0 0 0 0 388
Annual IC Cost Burden (Dollars) 9,700 0 0 0 0 9,700

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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