OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Medicare Registration Summary and Medication History Personal Health Record Evaluation (Discussion Group Burden)

IC 188766 under ICR 200810-0938-016 · OMB 0938-1058.

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

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Medicare Registration Summary and Medication History Personal Health Record Evaluation (Discussion Group Burden)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS - 10264 CMS - PHR Survey General CMS PHR survey_general.FINAL.pdf Yes No Fillable Fileable

Health Health Care Services

 

80 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 80 0 80 0 0 0
Annual IC Time Burden (Hours) 120 0 120 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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