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Federal forms, ICRs, and supporting documents

Information Collection

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

IC 214407 under ICR 201506-0938-013 · OMB 0938-1185.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

(CMS-10546) Survey for Long-Term (LT) and Post-Acute Care (PAC) Electronic Health Records (EHR) and Health Information Exchange (HIE) Adoption
 
Unchanged
 
Required to Obtain or Retain Benefits
 

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

Health Health Care Services

 

34,328 11,328
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 34,328 0 0 0 0 34,328
Annual IC Time Burden (Hours) 11,443 0 0 0 0 11,443
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.