Information Collection

CISS: Collection of Medical Records

IC 252878 under ICR 202508-2127-002 · OMB unassigned.

Documents and Forms

Document Name Document Type
ROCIS - Non CFR_Instrument Explanation.docx Other-Non CFR and Instrument Explana

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CISS: Collection of Medical Records	Agency IC Tracking Number:

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
Other-Non CFR and Instrument Explanation			ROCIS - Non CFR_Instrument Explanation.docx		No		Printable Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 628	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 24 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	21,760	5,109	16,651
Annual IC Time Burden (Hours)	3,627	844	2,783
Annual IC Cost Burden (Dollars)	0	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.

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