Information Collection

OMB No. 0917-0036 – Clinical Decision Support Usability Assessment

IC 215692 under ICR 201301-0917-001 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OMB No. 0917-0036 OMB No. 0917-0036 – Clinical Decision Support Usability Assessment	Form and Instruction
OMB No. 0917-0036 Clinical Decision Support Usabibility Assessment - Local Clinical Decision Support Usability Assessment - Local Clinical Reminders Su.pdf www.surveymonkey.com/r/C5GXP66	Form and Instruction
OMB No 0917-0036 Mini-supporting Statement for Clinical Decision Support Usability Assessment.doc OMB No. 0917-0036, Mini-supporting Statement for Clinical Decision Support Usability	IC Document

IC Title:

OMB No. 0917-0036 â Clinical Decision Support Usability Assessment

Agency IC Tracking Number:

IC Status: New

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
Form and Instruction	OMB No. 0917-0036	Clinical Decision Support Usabibility Assessment - Local Clinical Reminders	Clinical Decision Support Usability Assessment - Local Clinical Reminders Su.pdf	https://www.surveymonkey.com/r/C5GXP66	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB No. 0917-0036, Mini-supporting Statement for Clinical Decision Support Usability	OMB No 0917-0036 Mini-supporting Statement for Clinical Decision Support Usability Assessment.doc	03/18/2015

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