Information Collection

Pulling, Re-Filing Medical Forms (FR abstracts)

IC 213885 under ICR 201702-0920-007 · OMB 0920-0234.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0234 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att H - 2016 PRF Burden 122115.docx	Instruction
Att H - 2016 PRF Burden 122115.docx Att H - 2016 PRF Burden	IC Document

IC Title:

Pulling, Re-Filing Medical Forms (FR abstracts)

Agency IC Tracking Number:

17QY

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Att H - 2016 PRF Burden 122115.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20--0167 Health Resources Utilization Statistics

FR Citation: 49 FR 37697

Number of Respondents: 234

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: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	7,020	690	6,330
Annual IC Time Burden (Hours)	117	11	106
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att H - 2016 PRF Burden	Att H - 2016 PRF Burden 122115.docx	02/10/2016

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