OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

EHR data (Cohorts 1, 2, and 3)

IC 227723 under ICR 201906-0935-002 · OMB 0935-0238.

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

View Information Collection (IC)

EHR data (Cohorts 1, 2, and 3)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Attachment L Clinical measure instructions.1.docx Yes Yes Fillable Printable

Health Health Care Services

 

334 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved 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 4,008 0 0 0 0 4,008
Annual IC Time Burden (Hours) 4,008 0 0 0 0 4,008
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment K: Clinical measures template for EHR data extracts Att K Clinical measure template and data dictionary.pdf 07/26/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.