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Awardee interviews for the evaluation of the Advance Interoperable Health Information Technology to Support Health Information Exchange program
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (HITRC)
OMB: 0955-0003
IC ID: 227583
OMB.report
HHS/ONC
OMB 0955-0003
ICR 201408-0955-001
IC 227583
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0955-0003 can be found here:
2021-06-28 - Revision of a currently approved collection
2021-03-03 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
0955-0003 Logic_Model Instructions.docx
Other-Instruction
0955-0003 Closeout FAQs to send to interviewees.docx
Other-FAQ
0955-0003 Interview request template.docx
Other-interview
0955-0003 AHIE Interview Guide_Final_06-16-2017.docx
Other-guide
revisedGeneric_Clearance_Submission_LJ (3).doc
memo
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Awardee interviews for the evaluation of the Advance Interoperable Health Information Technology to Support Health Information Exchange program
Agency IC Tracking Number:
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
Other-Instruction
0955-0003 Logic_Model Instructions.docx
No
Paper Only
Other-FAQ
0955-0003 Closeout FAQs to send to interviewees.docx
No
Paper Only
Other-interview
0955-0003 Interview request template.docx
No
Paper Only
Other-guide
0955-0003 AHIE Interview Guide_Final_06-16-2017.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
12
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
12
0
12
0
0
0
Annual IC Time Burden (Hours)
18
0
18
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
memo
revisedGeneric_Clearance_Submission_LJ (3).doc
07/19/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.