OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Access to Electronic HCR during Outbreak and Assessment of State PHD Immunization Billing Reimbursement Projects

IC 211315 under ICR 201402-0920-018 · OMB 0920-0879.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Access to Electronic HCR during Outbreak and Assessment of State PHD Immunization Billing Reimbursement Projects 0920-14JS/0920-14TU
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0879 EHR Attachment A_Interview Guide HAI-Epi_041514 Attachment A_Interview Guide HAI-Epi_041514.docx Yes No Fillable Printable
Form and Instruction 0920-0879 EHR Attachment B_Interview Guide Counsel Attachment B_Interview Guide Counsel.docx Yes No Fillable Printable
Form and Instruction 0920-0879 EHR Attachment C_Instrument- Word- Phase 1 Attachment C_Interview Guide Informatics.docx Yes No Fillable Printable
Form and Instruction 0920-0879 IZPHD Attachment B_Instrument- Web-Phase 1 Attachment B_Instrument- Web-Phase 1.docx Yes No Fillable Printable
Form and Instruction 0920-0879 IZPHD Attachment C_Instrument- Word- Phase 1 Attachment C_Instrument- Word- Phase 1.docx Yes No Fillable Printable
Form and Instruction 0920-0879 IZPHD Attachment D -Interview Instrument- Phase 2 Attachment D -Interview Instrument- Phase 2.docx Yes No Fillable Printable

Health Consumer Health and Safety

 

110 0
   
State, Local, and Tribal Governments
 
   50 %

  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 110 0 110 0 0 0
Annual IC Time Burden (Hours) 61 0 61 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
EHR Supporting_Statement_A_041514 Supporting_Statement_A_041514.docx 04/18/2014
EHR Supporting_Statement_B_041514 Supporting_Statement_B_041514.docx 04/18/2014
EHR Attachment D_Intro Email_HAI_Epi Attachment D_Intro Email_HAI_Epi.docx 04/18/2014
EHR Attachment E- Invitation Email to HAI-EPI Attachment E- Invitation Email to HAI-EPI.docx 04/18/2014
EHR Attachment F-Invitation Email to Legal Counsel Attachment F-Invitation Email to Legal Counsel.docx 04/18/2014
EHR Attachment G- Invitation Email to Informatics Director Attachment G- Invitation Email to Informatics Director.docx 04/18/2014
EHR Attachment H- Reminder to HAI-EPI Attachment H- Reminder to HAI-EPI.docx 04/18/2014
EHR Attachment I-Reminder to Legal Counsel Attachment I-Reminder to Legal Counsel.docx 04/18/2014
EHR Attachment J-Reminder to Informatics Director Attachment J-Reminder to Informatics Director.docx 04/18/2014
IZPHD Supporting Statement A _IZ Funding Statement A _IZ Funding.docx 04/18/2014
IAPHD Supporting Statement B_IZ Funding Statement B_IZ Funding.docx 04/18/2014
IZPHD Attachment A_List HD Awardees Attachment A_List HD Awardees.docx 04/18/2014
IZPHD Attachment E Introductory Email- Phase 1 Attachment E Introductory Email- Phase 1.docx 04/18/2014
IZPHD Attachment F-Reminder Email- Phase 1 Attachment F-Reminder Email- Phase 1.docx 04/18/2014
IZPHD Attachment G -Follow-up Email- Phase 1 Attachment G -Follow-up Email- Phase 1.docx 04/18/2014
IZPHD Attachment H- Interview Introductory Email- Phase 2 Attachment H- Interview Introductory Email- Phase 2.docx 04/18/2014
IZPHD Attachment I- Interview Reminder Email- Phase 2 Attachment I- Interview Reminder Email- Phase 2.docx 04/18/2014
IZPHD Attachment J- Interview Follow-up Email- Phase 2 Attachment J- Interview Follow-up Email- Phase 2.docx 04/18/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.