Information Collection

HRSA Electronic Health Record Readiness Assessment

IC 189033 under ICR 200908-0915-004 · OMB 0915-0325.

Documents and Forms

Document Name Document Type
Form EHR readiness HRSA Electronic Health Record Readiness Assessment Form and Instruction
EHR readiness EHR Readiness Attachment A - EHR Checklist.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? No		IC Status: Modified

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	Attachment A - EHR Checklist.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	Previously Approved
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.