Information Collection

NCORP Electronic Medical Record (EMR) Survey (NCI)

IC 248699 under ICR 202002-0925-002 · OMB 0925-0642.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0642 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 EMR screenshot NCORP Electronic Medical Record (EMR) Survey (NCI)	Form
1 EMR screenshot EMR Screenshots 7.30.2021.pdf	Form
Fast Track NCORP EMR 7.30.2021.docx NCORP Electronic Medical Record (EMR) Survey (NCI)	IC Document
Email Message for 2021 EMR Survey.pdf email invite	IC Document

IC Title:

NCORP Electronic Medical Record (EMR) Survey (NCI)

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	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 96

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NCORP Electronic Medical Record (EMR) Survey (NCI)		08/04/2021
email invite		08/04/2021

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].