Information Collection

Generic Survey Clearance of the EHR Impact Data Base

IC 33019 under ICR 199911-3145-001 · OMB 3145-0136.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	Generic Survey Clearance of the EHR Impact Data Base	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 37,324	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 9 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	36,738	776	35,962
Annual IC Time Burden (Hours)	36,899	5,863	31,036
Annual IC Cost Burden (Dollars)	11,000	-537,000	548,000

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.