Add/Change Data Items in Volume I/II/V

Add/Change Data Items in Volume I/II/V Request Form

NAACCRVol_I_II_ChangeRequest

If you are submitting a change request, please only fill in fields to which you are suggesting changes.
NOTE: Fields marked with an asterisk (*) are required.

Request Addition/Change to:

Standards Volume I/II Standards Volume V

Request Type:

Add New Data Item Change Existing Data Item
Preliminary Request Final Request

Date of Request:

Name:*
Organization:
Phone:
Email:*
Proposed effective date:
Segment and Sequence(Volume V):
Data Item Name:
Data Item Number:
Data Item Length (No. of Chars.):
Description:
Rationale:
Allowable Values and Format:
Codes:
Organizational Source of Standard:
Comments:

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