Information Collection

Evaluation of the Electronic Records Demonstration ( Discussion Guide for pratices that withdrew)

IC 192045 under ICR 201002-0938-006 · OMB 0938-1072.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
C-EHRD Site Visit Discussion Guides - Withdrawn Practices 2-4-10.docx	Other-GUIDE FOR WITHDRAWN TREATMENT

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Other-GUIDE FOR WITHDRAWN TREATMENT GROUP PRACTICES			C-EHRD Site Visit Discussion Guides - Withdrawn Practices 2-4-10.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	3	3
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.