Information Collection

Support for Medical Record Abstraction

IC 221997 under ICR 201802-0920-012 · OMB 0920-1162.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1162 can be found here:

Documents and Forms

Document Name Document Type
Support for Medical Record Abstraction Form
Medical Record Abstraction Attachment 9. Chart Abstraction Form.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Support for Medical Record Abstraction	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	none	Medical Record Abstraction	Attachment 9. Chart Abstraction Form.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,002	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,002	1,002
Annual IC Time Burden (Hours)	84	84
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.