Information Collection

Disease Classification

IC 237622 under ICR 202103-0915-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Form 2402 R5.pdf Disease Classification Form 2402 R5.pdf	Form
2 Form 2402 R5.pdf Disease Classification Form 2402 R5.pdf	Form
2-2 Draft 2402 R6.docx Disease Classification 2 Draft 2402 R6.docx	Form
2-2 Draft 2402 R6.docx Disease Classification 2 Draft 2402 R6.docx	Form
03.11.2020 Disease Classification Form 2402 Proposed Changes.docx Proposed Changes to Form	IC Document
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: Unchanged

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	Form 2402 R5.pdf Disease Classification	Form 2402 R5.pdf		Yes	Yes	Fillable Fileable
Form	2-2	Draft 2402 R6.docx Disease Classification 2	Draft 2402 R6.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: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	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.