Information Collection Request

Electronic Health Records (EHR) Demonstration System (EHRDS) - practice application and profile update system

ICR 201008-0938-001 · OMB 0938-0965 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Crosswalk_4192010.doc Supplementary Document Uploaded 2010-07-16 Available
cover memo 03082010.doc Supplementary Document Uploaded 2010-07-16 Available
PRA screen proposed for EHRDS 04192010.doc Supplementary Document Uploaded 2010-07-16 Available
PRA_for web enabled EHR application Sup Statement Part A -demo practice update system REVISED 04192010.doc Supporting Statement A Uploaded 2010-07-16 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
8825 Electronic Health Records (EHR) Demonstration System (EHRDS) - practice application and profile update system(CMS-10165) Other-Screen Prints Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2013 36 Months From Approved 06/30/2011
313 0 2,400
52 0 520
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Electronic Health Records (EHR) Demonstration System (EHRDS) - practice application and profile update system(CMS-10165)

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 313 2,400 0 -2,087 0 0
Annual Time Burden (Hours) 52 520 0 -468 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No