CMS-10296.DRAFT 2010 Inpatient EHR Testing Application

Electronic Health Records (EHR) Testing

Documents and Forms

Document Name Document Type
Form CMS-10296 CMS-10296.DRAFT 2010 Inpatient EHR Testing Application Form and Instruction
CMS-10296 CMS-10296 - 2010 Inpatient EHR Testing Application CMS-10296.2010 Inpatient EHR Testing Application 05-06-10.docx Form and Instruction

Information Collection (IC) Details

IC Title:	CMS-10296.DRAFT 2010 Inpatient EHR Testing Application	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 and Instruction	CMS-10296	CMS-10296 - 2010 Inpatient EHR Testing Application	CMS-10296.2010 Inpatient EHR Testing Application 05-06-10.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 55	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	55	55
Annual IC Time Burden (Hours)	28,655	28,655
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.