OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Awardee interviews for the evaluation of the Advance Interoperable Health Information Technology to Support Health Information Exchange program

IC 227583 under ICR 201408-0955-001 · OMB 0955-0003.

Documents and Forms

Documents and forms in this information collection
Document NameDocument 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)

layout table

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-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


table that charts list of burden
  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
table that charts IC Documents
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.