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

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (CMS-10415)

⚠️ Notice: This information collection may be referencing outdated material.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-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

Information Collection (IC) Details

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:

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 %

	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

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.