Information Collection

Health Care Provider PHI Access Online Survey

IC 214006 under ICR 201407-0955-001 · OMB 0955-0005.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0955-0005SHARPS Survey_101014.docx	Other-survey
0955-0005 final instrumentAppendixB.docx	Other-survey
0955-0005Generic_Clearance_Submission_SHARPS.docx Health Care Provider PHI Access Online memo	IC Document
final supporting statement - onc.doc Generic supporting statement	IC Document
onc email AppendixA.docx email outreach	IC Document

IC Title:

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
Other-survey			0955-0005 final instrumentAppendixB.docx		Yes	Yes	Fillable Printable
Other-survey			0955-0005SHARPS Survey_101014.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Health Care Provider PHI Access Online memo	0955-0005Generic_Clearance_Submission_SHARPS.docx	11/20/2014
Generic supporting statement	final supporting statement - onc.doc	12/05/2014
email outreach	onc email AppendixA.docx	12/05/2014

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