Pulling and Refiling Medical Records

Ambulatory Care Pretest: National Hospital Care Survey

Documents and Forms

Document Name Document Type
Form 5 Pulling and Refiling Medical Records Form
5 Pulling and Refiling Records Att M Pulling records draft.docx Form

Information Collection (IC) Details

IC Title:	Pulling and Refiling Medical Records	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	5	Pulling and Refiling Records	Att M Pulling records draft.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: Health Resources Utilization Statistics	FR Citation: 49 FR 37693

Number of Respondents: 140	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,560	14,560
Annual IC Time Burden (Hours)	243	243
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.