Information Collection

57.403 Outpatient Procedure Component - Monthly Denominators and Summary

IC 208407 under ICR 202102-0920-011 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC 57.403 57.403 Outpatient Procedure Component - Monthly Denominators and Summary	Form
CDC 57.403 Outpatient Procedure - Monthly Denominators and Summary 57.403_OPC_SD_DENOM_BLANK.docx	Form
G17. Outpatient Procedure Component.pdf Att G17_Outpatient Procedure Component	IC Document

IC Title:

57.403 Outpatient Procedure Component - Monthly Denominators and Summary

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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
Form	CDC 57.403	Outpatient Procedure - Monthly Denominators and Summary	57.403_OPC_SD_DENOM_BLANK.docx		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: Businesses or other for-profits, 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	80,000	80,000
Annual IC Time Burden (Hours)	53,333	53,333
Annual IC Cost Burden (Dollars)	1,730,640	1,730,640

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att G17_Outpatient Procedure Component	G17. Outpatient Procedure Component.pdf	08/08/2016

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