Information Collection

Military Health System Electronic Health Record End User Survey

IC 253193 under ICR 202203-0704-006 · OMB 0704-0553.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.