Medicare Registration Summary and Medication History Personal Health Record Evaluation (Beneficiaries)

Medicare Registration Summary and Medication History Personal Health Record Evaluation

OMB: 0938-1058

IC ID: 187047

Information Collection (IC) Details

View Information Collection (IC)

Medicare Registration Summary and Medication History Personal Health Record Evaluation (Beneficiaries)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CM-10264 CMs-10264 Survey Instrument Attachment 3 - CMS PHR survey final draft.pdf Yes No Fillable Fileable

Health Health Care Services

 

2,160 0
   
Individuals or Households
 
   0 %

  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 2,160 0 2,160 0 0 0
Annual IC Time Burden (Hours) 1,080 0 1,080 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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