Information Collection

Retrieve Medical Records 2020

IC 214305 under ICR 202201-0920-017 · OMB 0920-0278.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment K1 - Retrieving Medical Records (2020).docx	Instruction
Attachment K1 - Retrieving Medical Records (2020).docx	Instruction

IC Title:

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
Instruction			Attachment K1 - Retrieving Medical Records (2020).docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health Resources Utilization Statistics

FR Citation: 49 FR 37693

Number of Respondents: 137

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: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	13,700	13,700
Annual IC Time Burden (Hours)	228	228
Annual IC Cost Burden (Dollars)	4,384	4,384

Documents for IC

table that charts IC Documents
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.