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Federal forms, ICRs, and supporting documents

Information Collection

Request for Medical Record Abstraction

IC 237378 under ICR 202110-0923-001 · OMB 0923-0061.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Information Collection (IC) Details

View Information Collection (IC)

Request for Medical Record Abstraction
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction P_Att19_RequestMedicalRecAbstrctn_20190813 clean.docx Yes No Paper Only

Health Public Health Monitoring

Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances  76 FR 4432

10 0
   
Private Sector Businesses or other for-profits
 
   0 %

  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 550 0 0 0 0 550
Annual IC Time Burden (Hours) 183 0 0 0 0 183
Annual IC Cost Burden (Dollars) 10,024 0 0 0 0 10,024

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.