Adult Discharge Audit Case Report Form

All Age Influenza Hospitalization Surveillance Project

OMB: 0920-0806

IC ID: 184757

Information Collection (IC) Details

View Information Collection (IC)

Adult Discharge Audit Case Report Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 3 Adult Discharge Audit Case Report Form Attachment 5 Discharge Audit Case Report Form.doc Yes Yes Fillable Fileable

Health Public Health Monitoring

 

11 0
   
State, Local, and Tribal Governments
 
   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 33 0 33 0 0 0
Annual IC Time Burden (Hours) 8 0 8 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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