Information Collection

Evaluation of the Electronic Health Records Demonstration (Office System Survey Val Form)

IC 191858 under ICR 201002-0938-006 · OMB 0938-1072.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10273 Evaluation of the Electronic Health Records Demonstration (Office System Survey Val Form)	Form and Instruction
CMS-10273 Office System Survey Validation Form EHRD-OSS validation form 11-26-08.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10273	Office System Survey Validation Form	EHRD-OSS validation form 11-26-08.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 485

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	97	97
Annual IC Time Burden (Hours)	134	134
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.