Information Collection

Pulling and re-filing Patient Record form (Line 4)

IC 181891 under ICR 201309-0920-004 · OMB 0920-0234.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0234 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att T Pulling and Re-filing.pdf	Instruction
Att EE 2012 NAMCS Re-abstraction Study Pulling and Re-filing.pdf Att EE 2012 NAMCS Re-abstraction Study Pulling and Re-filing	IC Document

IC Title:

Pulling and re-filing Patient Record form (Line 4)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Att T Pulling and Re-filing.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: 09-20-0167 Health Resources Utilization Statistics

FR Citation: 49 FR 37693

Number of Respondents: 13,627

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: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	408,810	408,810
Annual IC Time Burden (Hours)	6,814	6,814
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att EE 2012 NAMCS Re-abstraction Study Pulling and Re-filing	Att EE 2012 NAMCS Re-abstraction Study Pulling and Re-filing.pdf	12/12/2011

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