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Survey Respondents
Comprehensive Communication Campaign for HITECH ACT
OMB: 0955-0005
IC ID: 200924
OMB.report
HHS/ONC
OMB 0955-0005
ICR 201208-0955-005
IC 200924
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0955-0005 can be found here:
2014-07-09 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
0990-0376_Survey for Developing Education for Sharing Patient Medical Info_eConsent_Survey_v1.docx
Other-survey
0990-0376_Survey for Developing Education for Sharing Patient Medical Info_eConsent_cover_letter_v1.docx
0990-0376_Survey for Developing Education for Sharing Patient Medical Info_eConsent_cover_letter_v1
IC Document
0990-0376_Mini Supporting Statement Cognitive Testing Consumer Privacy Security.docx
mini supporting st
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Survey Respondents
Agency IC Tracking Number:
IC Status:
New
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-survey
0990-0376_Survey for Developing Education for Sharing Patient Medical Info_eConsent_Survey_v1.docx
No
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,800
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
2,800
0
0
0
0
0
Annual IC Time Burden (Hours)
233
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
0990-0376_Survey for Developing Education for Sharing Patient Medical Info_eConsent_cover_letter_v1
0990-0376_Survey for Developing Education for Sharing Patient Medical Info_eConsent_cover_letter_v1.docx
01/10/2012
mini supporting st
0990-0376_Mini Supporting Statement Cognitive Testing Consumer Privacy Security.docx
01/10/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.