Information Collection

Retrieve Medical Records 2021

IC 214307 under ICR 202201-0920-017 · OMB 0920-0278.

Documents and Forms

Document Name Document Type
Attachment K2 - Retrieving Medical Records (2021).docx Instruction
Attachment K2 - Retrieving Medical Records (2021).docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Retrieve Medical Records 2021	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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			Attachment K2 - Retrieving Medical Records (2021).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health Resources Utilization Statistics	FR Citation: 49 FR 37693

Number of Respondents: 410	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	41,000	41,000
Annual IC Time Burden (Hours)	683	683
Annual IC Cost Burden (Dollars)	13,120	13,120

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.