Medical Record Review

Birth Defects Study to Evaluate Pregnancy exposureS (BD-STEPS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0010 can be found here:

Documents and Forms

Document Name Document Type
Medical Records Reviewers Form.docx Instruction
AttZ1_MedRecPatientRequestLtr_English.pdf Att Z1 - Medical Records Request Letter -English IC Document
AttZ2_MedRecPatientRequestLtr_Spanish.pdf Att Z2 - Medical Records Request Letter - Spanish IC Document

Information Collection (IC) Details

IC Title:	Medical Record Review	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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
Instruction			Medical Records Reviewers Form.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 475	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-475	475
Annual IC Time Burden (Hours)	-238	238
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att Z1 - Medical Records Request Letter -English	AttZ1_MedRecPatientRequestLtr_English.pdf	08/03/2016
Att Z2 - Medical Records Request Letter - Spanish	AttZ2_MedRecPatientRequestLtr_Spanish.pdf	08/03/2016

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