OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Health Care Provider PHI Access Online Survey

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

Documents and Forms
Document Name
Document Type
Other-survey
Other-survey
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Health Care Provider PHI Access Online Survey
 
New
 
Voluntary
 

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

Health Consumer Health and Safety

 

3,000 0
   
Private Sector Businesses or other for-profits
 
   0 %

  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 3,000 0 3,000 0 0 0
Annual IC Time Burden (Hours) 500 0 500 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.