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57.400 Outpatient Procedure - Annual Facility Survey

IC 208404 under ICR 202408-0920-016 · OMB 0920-0666.

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57.400 Outpatient Procedure - Annual Facility Survey 0920-0666
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CDC 57.400 Outpatient Procedure Component - Annual Facility Survey 57.400_ASCFacSurv_BLANK.DOCX Yes Yes Fillable Fileable

Health Health Care Services

 

350 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 350 0 0 0 0 350
Annual IC Time Burden (Hours) 58 0 0 0 0 58
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att G17_Outpatient Procedure Component G17. Outpatient Procedure Component.pdf 08/08/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.