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.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10546 Utilization of Health Information Technology in Post-Acute Care Settings (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

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: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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
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 %

table that charts list of burden
	Requested	Previously Approved
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

table that charts IC Documents
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.