Information Collection

Electronic Medical Documentation Interoperability (EMDI) Workgroup Survey (CMS-10679)

IC 235900 under ICR 201904-0938-017 · 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⚠️ Notice: This information collection may be referencing outdated material.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-10679 Electronic Medical Documentation Interoperability (EMDI) Workgroup Survey (CMS-10679)	Form and Instruction
CMS-10679 EMDI_Workgroup_Participation_Survey CMS-10679 - EMDI_Workgroup_Participation_Survey.docx	Form and Instruction
CMS-10679 - EMDI_Workgroup Survey_PRA_Generic_Clearance_Template-Final.docx Electronic Medical Documentation Interoperability (EMDI) Workgroup Survey	IC Document

IC Title:

Electronic Medical Documentation Interoperability (EMDI) Workgroup Survey (CMS-10679)

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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-10679	EMDI_Workgroup_Participation_Survey	CMS-10679 - EMDI_Workgroup_Participation_Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Electronic Medical Documentation Interoperability (EMDI) Workgroup Survey	CMS-10679 - EMDI_Workgroup Survey_PRA_Generic_Clearance_Template-Final.docx	04/30/2019

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