Military Health System Electronic Health Record End User Survey

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0553 can be found here:

Documents and Forms

Document Name Document Type
MAX Survey - Military Health System Electronic Health Record End User Su.._.pdf Other-Survey
EHR ADN.pptx ADN IC Document
0703-0553_EHR End User Survey_9.6.19.docx One Pager IC Document

Information Collection (IC) Details

IC Title:	Military Health System Electronic Health Record End User Survey	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
Other-Survey			MAX Survey - Military Health System Electronic Health Record End User Su.._.pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25,000	25,000
Annual IC Time Burden (Hours)	4,167	4,167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ADN	EHR ADN.pptx	10/03/2019
One Pager	0703-0553_EHR End User Survey_9.6.19.docx	10/03/2019

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