Information Collection Request

Evaluation of the Medicare Care Management Performance Demonstration and the Electronic Health Records Demonstration

ICR 201001-0938-007 · OMB 0938-1072 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10273 Office System Survey Form and Instruction New Available
Form CMS-10273 Office System Survey Validation Form Form and Instruction New Available
1-EHRDPRAOMB_C.pdf Supporting Statement B Uploaded 2010-01-27 Available
1-EHRDPRAOMB_A_B.pdf Supporting Statement A Uploaded 2010-01-27 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
191859 Evaluation of the Electronic Health Records Demonstration (Office System Survey) Form and Instruction NewOffice System Survey
191858 Evaluation of the Electronic Health Records Demonstration (Office System Survey Val Form) Form and Instruction NewOffice System Survey Validation Form
189571 Evaluation of the Medicare Care Management Performance Demonstration (Office System Survey) Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2013 36 Months From Approved 10/31/2012
1,577 0 980
844 0 470
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
Evaluation of the Electronic Health Records Demonstration (Office System Survey Val Form) CMS-10273
Evaluation of the Electronic Health Records Demonstration (Office System Survey) CMS-10273
Evaluation of the Medicare Care Management Performance Demonstration (Office System Survey)

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,577 980 0 597 0 0
Annual Time Burden (Hours) 844 470 0 374 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No