Health care provider follow up

A PROTOTYPE CONSUMER REPORTING SYSTEM FOR PATIENT SAFETY EVENTS

OMB: 0935-0214

IC ID: 207256

Documents and Forms
Information Collection (IC) Details

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Health care provider follow up
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #4 Health care provider follow-up form Attachment G -- Health Care Provider Followup.docx Yes Yes Fillable Fileable

Health Immunization Management

 

84 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 84 0 84 0 0 0
Annual IC Time Burden (Hours) 28 0 28 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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