Attachment K Sample Listing Sheet NHDS Redesign OMB No. 0920-0212: Approval expires 10/31/2011
Notice - Public reporting burden for this collection of information is estimated to average 14 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to: CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0212).
Assurances of Confidentiality – All information which would permit identification of any individual, a practice, or an establishment will be held confidential, will be used only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).
The 250 FSASCs selected to participate will be asked to transmit UB-04 claims data on a quarterly basis. We expect that staff will take an average of 1 hour to prepare and transit the data files. This equals 1,000 annualized hours over three years.
10/20/09
| File Type | application/msword |
| File Title | ATTACHMENT O |
| Author | Christine Lucas |
| Last Modified By | CDC User |
| File Modified | 2013-01-23 |
| File Created | 2013-01-23 |