Dialysis–related Cardiac Arrest Data Collection Tool for data received through Case Finding

Undetermined Cause of Cardiac Arrest during Hemodialysis — Connecticut 2015-2016

OMB: 0920-1095

IC ID: 219766

Information Collection (IC) Details

View Information Collection (IC)

Dialysis–related Cardiac Arrest Data Collection Tool for data received through Case Finding
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Dialysis-related Cardiac Arrest Data Collection Tool for data received through Case Finding Att 6 - Data collection for case finding.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62812

10 0
   
Individuals or Households
 
   100 %

  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 10 0 10 0 0 0
Annual IC Time Burden (Hours) 5 0 5 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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