Information Collection

Adult Discharge Audit Form A: Description of Matching Method

IC 184758 under ICR 200805-0920-002 · OMB 0920-0806.

Documents and Forms

Document Name Document Type
Form 4 Adult Discharge Audit Form A: Description of Matching Method Form
4 Adult Discharge Audit Form A: Description of Matching Me Attachment 6 Matching Method.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adult Discharge Audit Form A: Description of Matching Method	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	4	Adult Discharge Audit Form A: Description of Matching Method	Attachment 6 Matching Method.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11	11
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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