Information Collection

EHR Vendor

IC 209960 under ICR 201208-0955-005 · OMB 0955-0005.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0955-0005 can be found here:

Documents and Forms

Document Name Document Type
0955-0005HQMF Vendor SurveyREV.docx Other-survey
21305 ID_NTB submission fast-track-PRA-submission-short-form_EHR Vendor Survey final.docx 21305 ID_NTB submission fast-track-PRA-submission-short-form_EHR Vendor Survey final IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	EHR Vendor	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			0955-0005HQMF Vendor SurveyREV.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	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	100	0	0	0	0	0
Annual IC Time Burden (Hours)	8	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
21305 ID_NTB submission fast-track-PRA-submission-short-form_EHR Vendor Survey final	21305 ID_NTB submission fast-track-PRA-submission-short-form_EHR Vendor Survey final.docx	01/08/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.