Information Collection

Prepare and transmit EHR for Visit Data (quarterly) (2022)

IC 247678 under ICR 202210-0920-012 · OMB 0920-0234.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0234 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0234 Prepare and transmit EHR for Visit Data (quarterly) (2022)	Form and Instruction
0920-0234 Attachment O1_NAMCS EHR Record Pulling Burden Attachment O1_NAMCS EHR Record Pulling Burden.docx	Form and Instruction
0920-0234 Attachment O1_NAMCS EHR Record Pulling Burden Attachment O1_NAMCS EHR Record Pulling Burden.docx	Form and Instruction

IC Title:

Prepare and transmit EHR for Visit Data (quarterly) (2022)

Agency IC Tracking Number:

0920-0234

Is this a Common Form? No

IC Status: Modified

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 and Instruction	0920-0234	Attachment O1_NAMCS EHR Record Pulling Burden	Attachment O1_NAMCS EHR Record Pulling Burden.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 33

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	132	-236	368
Annual IC Time Burden (Hours)	132	-236	368
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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