Information Collection

Attachment J - Subsequent data pull for 10% of units

IC 256475 under ICR 202209-0935-004 · OMB 0935-0260.

Documents and Forms

Document Name Document Type
Form 9.5 Attachment J - Subsequent data pull for 10% of units Form and Instruction
9.5 Attachment J - Subsequent data pull for 10% of units Att J Clinical Outcomes Data for ICU-Non-ICU_22.05.05 (1).docx Form and Instruction
9.5 Attachment J - Subsequent data pull for 10% of units Att J Clinical Outcomes Data for ICU-Non-ICU_22.05.05 (1).docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment J - Subsequent data pull for 10% of units	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	9.5	Attachment J - Subsequent data pull for 10% of units	Att J Clinical Outcomes Data for ICU-Non-ICU_22.05.05 (1).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 27	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	81	81
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.