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Federal forms, ICRs, and supporting documents

Information Collection

Electronic Health Records (EHR) Demonstration System (EHRDS) - practice application and profile update system(CMS-10165)

IC 8825 under ICR 201008-0938-001 · OMB 0938-0965.

Documents and Forms
Document Name
Document Type
Other-Screen Prints
IC Document
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Electronic Health Records (EHR) Demonstration System (EHRDS) - practice application and profile update system(CMS-10165)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screen Prints Screens 030410.doc Yes Yes Paper Only

Health Health Care Services

Master Demonstration, Evaluation and Research Studies" system of records for the Office of Research, Development and Information," System No. 09-70-0591   72 FR 17918

400 400
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 313 0 -2,087 0 0 2,400
Annual IC Time Burden (Hours) 52 0 -468 0 0 520
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
PRA screen proposed for EHRDS 04192010 PRA screen proposed for EHRDS 04192010.doc 07/16/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.