Information Collection

HRSA Electronic Health Record Readiness Assessment

IC 189033 under ICR 200905-0915-002 · OMB 0915-0325.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0325 can be found here:

Documents and Forms

Document Name Document Type
Form EHR readiness HRSA Electronic Health Record Readiness Assessment Form and Instruction
EHR readiness EHR Readiness CIP revised.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HRSA Electronic Health Record Readiness Assessment	Agency IC Tracking Number:

Is this a Common Form?		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	EHR readiness	EHR Readiness	CIP revised.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 568	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	568	568
Annual IC Time Burden (Hours)	142	142
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.