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

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	OMB No. 0917-0036 – Clinical Decision Support Usability Assessment	Agency IC Tracking Number:	51

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
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 %

	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

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.