Pull Medical Records

[NCHHSTP] Medical Monitoring Project

Documents and Forms

Document Name Document Type
Att 8f Facility pull medical records.docx Instruction
Att 8f Facility pull medical records.docx Instruction

Information Collection (IC) Details

IC Title:	Pull Medical Records	Agency IC Tracking Number:	0920-0740

Is this a Common Form? No		IC Status: Modified

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
Instruction			Att 8f Facility pull medical records.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,760	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	7,760	7,760
Annual IC Time Burden (Hours)	388	388
Annual IC Cost Burden (Dollars)	9,700	9,700

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.