Information Collection

Emergency Department Discharge Tool (EDT)

IC 210531 under ICR 201402-0935-002 · OMB 0935-0217.

Documents and Forms

Document Name Document Type
Form 1 Emergency Department Discharge Tool (EDT) Form and Instruction
1 Emergency Department Discharge Tool (EDT) Attachment A - ED Discharge High Risk Screening Checklist Tool 2013.12.13.docx Form and Instruction
Attachment B - EDT User Guide 2013.12.13.docx Attachment B - EDT User Guide 2013 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Emergency Department Discharge Tool (EDT)	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 and Instruction	1	Emergency Department Discharge Tool (EDT)	Attachment A - ED Discharge High Risk Screening Checklist Tool 2013.12.13.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 900	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment B - EDT User Guide 2013	Attachment B - EDT User Guide 2013.12.13.docx	02/21/2014

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