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57.504 Prevention Process Measures Monthly Monitoring for Dialysis

IC 208409 under ICR 202104-0920-002 · OMB 0920-0666.

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57.504 Prevention Process Measures Monthly Monitoring for Dialysis 0920-0666
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CDC 57.504 Prevention Process Measures Monthly Monitoring for Dialysis 57.504_DIALProcessMeasureSummary_BLANK.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,730 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 20,760 0 0 0 0 20,760
Annual IC Time Burden (Hours) 25,950 0 0 0 0 25,950
Annual IC Cost Burden (Dollars) 842,067 0 0 0 0 842,067

Title Document Date Uploaded
Att G11_Dialysis Prevention Process Measures 11. Dialysis Prevention Process Measures.pdf 09/26/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.