Military Health System Electronic Health Record End User Survey

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

Documents and Forms

Document Name Document Type
MAX Survey - Military Health System Electronic Health Record End User Su.._.pdf Other-Survey
One-Pager_EHR End User Survey_4.15.22.docx One-Pager MHS Electronic Health Record End User Survey 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: 2,500	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	2,500	2,500
Annual IC Time Burden (Hours)	417	417
Annual IC Cost Burden (Dollars)	3,125	3,125

Documents for IC

Title	Document	Date Uploaded
One-Pager MHS Electronic Health Record End User Survey	One-Pager_EHR End User Survey_4.15.22.docx	05/03/2022

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