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

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

Documents and Forms

Document Name Document Type
Form CMS-10273 Evaluation of the Electronic Health Records Demonstration (Office System Survey) Form and Instruction
CMS-10273 Office System Survey EHRD-OMB OSS w ARRA questions.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Evaluation of the Electronic Health Records Demonstration (Office System Survey)	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	EHRD-OMB OSS w ARRA questions.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,500	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	500	500
Annual IC Time Burden (Hours)	240	240
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.