OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Att E_Patient Information Form (PIF)

IC 192452 under ICR 201612-0920-005 · OMB 0920-0852.

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

View Information Collection (IC)

Att E_Patient Information Form (PIF) 0920-0852
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form Phase 4_PIF_20141218 Patient Information Form (PIF) Att E - PIF.pdf Yes No Fillable Printable

Health Public Health Monitoring

 

100 0
   
Private Sector Not-for-profit institutions
 
   50 %

  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 6,300 0 0 0 0 6,300
Annual IC Time Burden (Hours) 1,785 0 0 0 0 1,785
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att G_ Antimicrobial Use Form Att G - AUF and HAIF.pdf 09/19/2016
Att J_EIP Healthcare Facility Assessment Att J - EIP HFA.pdf 09/19/2016
Att K_Antimicrobial Quality Assessment (AQUA) Form 1 Att K - AQUA Forms.pdf 09/19/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.