Main Survey

Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Electronic Health Information Exchange

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0398 can be found here:

Documents and Forms

Document Name Document Type
HHS ONC Questionnaire FinalMain_080112.docx Other-Survey
Spanish HHS ONC Questionnaire FinalMain_080112.docx Other-Survey - Spanish
HHS ONC Survey Introduction and Consent Script_NORC 080112.docx Survey Script - English IC Document
Spanish HHS ONC Survey Introduction and Consent Script_NORC 080112.docx Survey Script - Spanish IC Document

Information Collection (IC) Details

IC Title:	Main Survey	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-Survey			HHS ONC Questionnaire FinalMain_080112.docx		Yes	Yes	Fillable Fileable
Other-Survey - Spanish			Spanish HHS ONC Questionnaire FinalMain_080112.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Survey Script - English	HHS ONC Survey Introduction and Consent Script_NORC 080112.docx	08/01/2012
Survey Script - Spanish	Spanish HHS ONC Survey Introduction and Consent Script_NORC 080112.docx	08/01/2012

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