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Federal forms, ICRs, and supporting documents

Information Collection

Pull Medical Records

IC 180569 under ICR 202503-0920-027 · OMB 0920-0740.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Information Collection (IC) Details

View Information Collection (IC)

Pull Medical Records 0920-0740
 
No Unchanged
 
Voluntary
 

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

Health Public Health Monitoring

 

7,760 0
   
Individuals or Households
 
   100 %

  Approved 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 7,760 0 0 0 0 7,760
Annual IC Time Burden (Hours) 388 0 0 0 0 388
Annual IC Cost Burden (Dollars) 9,700 0 0 0 0 9,700

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.
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