Information Collection

Disease Classification

IC 237622 under ICR 202003-0915-002 · OMB 0915-0310.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0310 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Disease Classification	Form
2 Disease Classification FormDiseaseClassification.pdf	Form
03.11.2020 Disease Classification Form 2402 Proposed Changes.docx Proposed Changes to Form	IC Document

IC Title:

Disease Classification

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form	2	Disease Classification	FormDiseaseClassification.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	9,600	9,600
Annual IC Time Burden (Hours)	4,160	4,160
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Proposed Changes to Form	03.11.2020 Disease Classification Form 2402 Proposed Changes.docx	03/16/2020

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