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Federal forms, ICRs, and supporting documents

Information Collection

Clinical Data Elements (CCDE)

IC 179134 under ICR 201304-0920-004 · OMB 0920-0745.

Documents and Forms
Document Name
Document Type
Other-Data Definition Table
Other-Entry to Web Portal Screenshot
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Clinical Data Elements (CCDE)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Data Definition Table Attachment 3b. CCDE Data Definition Table.docx Yes Yes Fillable Fileable
Other-Entry to Web Portal Screenshot Attachment 3a. CCDE Submission Web portal.doc Yes Yes Fillable Fileable

Health Illness Prevention

 

29 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 10,875 0 0 1,125 0 9,750
Annual IC Time Burden (Hours) 2,719 0 0 281 0 2,438
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Data Users Manual Attachment 3c. CCDE Data Users Manual.docx 03/14/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.