Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort

The AHRQ Safety Program for Telemedicine: Improving the Diagnostic Process and Improving Antibiotic Use

Documents and Forms

Document Name Document Type
Form 10 Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort Form and Instruction
10 Attachment J: Clinical Data Collection Instrument_Cancer Att J_Clinical Data Collection Form_Cancer Diagnostic Process Cohort 1.26.2023.docx Form and Instruction
10 Attachment J: Clinical Data Collection Instrument_Cancer Att J_Clinical Data Collection Form_Cancer Diagnostic Process Cohort 1.26.2023.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort	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	10	Attachment J: Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort	Att J_Clinical Data Collection Form_Cancer Diagnostic Process Cohort 1.26.2023.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	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: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,860	4,860
Annual IC Time Burden (Hours)	1,620	1,620
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.