Information Collection

EHR Adoption in Ambulatory Physician Care Practices

IC 180147 under ICR 200705-0990-001 · OMB 0990-0312.

Documents and Forms

Document Name Document Type
Form Appendix B EHR Adoption in Ambulatory Physician Care Practices Form
Appendix B Physician Survey Appendix B 5.14.2007.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	EHR Adoption in Ambulatory Physician Care Practices	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Form	Appendix B	Physician Survey	Appendix B 5.14.2007.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	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.