Information Collection

57.402 Outpatient Procedure - Event

IC 208406 under ICR 201508-0920-001 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Document Name Document Type
Form CDC 57.402 57.402 Outpatient Procedure - Event Form
CDC 57.402 Outpatient Procedure - Event 57.402_OPCEvent_BLANK.DOCX Form
Att G16_Outpatient Procedure Component.pdf Att G16_Outpatient Procedure Component IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.402 Outpatient Procedure - Event	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	CDC 57.402	Outpatient Procedure - Event	57.402_OPCEvent_BLANK.DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	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: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	125,000	125,000
Annual IC Time Burden (Hours)	83,333	83,333
Annual IC Cost Burden (Dollars)	2,623,333	2,623,333

Documents for IC

Title	Document	Date Uploaded
Att G16_Outpatient Procedure Component	Att G16_Outpatient Procedure Component.pdf	09/09/2015

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