Facility Staff Medical Record Abstraction

Medical Monitoring Project

OMB: 0920-0740

IC ID: 180565

Information Collection (IC) Details

View Information Collection (IC)

Facility Staff Medical Record Abstraction
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Att_3a_MMP abstraction_MHF_v7 1 0.doc Yes Yes Printable Only
Instruction Att_3b_MMP abstraction SPSF_v7 1 0.doc Yes Yes Printable Only
Instruction Att_3c_MMP abstraction SPVF_v7 1 0.doc Yes Yes Printable Only
Instruction Att_3d_MMP abstraction SPIF_v7 1 0.doc Yes Yes Printable Only

Health Public Health Monitoring

 

7,520 7,520
   
State, Local, and Tribal Governments
 
   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 7,520 0 0 0 0 7,520
Annual IC Time Burden (Hours) 376 0 0 0 0 376
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att_4 minimum data set Att_4 minimum data set.docx 03/26/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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