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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluation of the Electronic Health Records Demonstration (Office System Survey Val Form)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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-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 %

	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

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.