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

Documents and forms in this information collection
Document Name	Document Type
Screens 030410.doc	Other-Screen Prints
PRA screen proposed for EHRDS 04192010.doc PRA screen proposed for EHRDS 04192010	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-Screen Prints			Screens 030410.doc		Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

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

FR Citation: 72 FR 17918

Number of Respondents: 400

Number of Respondents for Small Entity: 400

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	313	-2,087	2,400
Annual IC Time Burden (Hours)	52	-468	520
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.