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

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

Documents and Forms

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

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:

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

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 %

	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

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.