(CMS-10546) Survey for Long-Term (LT) and Post-Acute Care (PAC) Electronic Health Records (EHR) and Health Information Exchange (HIE) Adoption

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1185 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10546 (CMS-10546) Survey for Long-Term (LT) and Post-Acute Care (PAC) Electronic Health Records (EHR) and Health Information Exchange (HIE) Adoption Form and Instruction
CMS-10546 Utilization of Health Information Technology in Post-Acu EHR_Survey_FINAL_Approved for use_11.11.2014.pdf Form and Instruction
Fast-Track-PRA-Form-fo- LTPAC-EHR-HIE-Usage-Survey-2014-2014-11-12.doc+smandl.doc Survey for Long-Term (LT) and Post-Acute Care (PAC) Electronic Health Records (EHR) and Health Information Exchange (HIE) Adopti IC Document

Information Collection (IC) Details

IC Title:	(CMS-10546) Survey for Long-Term (LT) and Post-Acute Care (PAC) Electronic Health Records (EHR) and Health Information Exchange (HIE) Adoption	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10546	Utilization of Health Information Technology in Post-Acute Care Settings	EHR_Survey_FINAL_Approved for use_11.11.2014.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 34,328	Number of Respondents for Small Entity: 11,328

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	34,328	34,328
Annual IC Time Burden (Hours)	11,443	11,443
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Survey for Long-Term (LT) and Post-Acute Care (PAC) Electronic Health Records (EHR) and Health Information Exchange (HIE) Adoption	Fast-Track-PRA-Form-fo- LTPAC-EHR-HIE-Usage-Survey-2014-2014-11-12.doc+smandl.doc	12/23/2014

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