Information Collection

Disease Classification

IC 237622 under ICR 202004-0915-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Disease Classification	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection 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 %

	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

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.