Information Collection

US Core Data for Interoperability (USCDI) New Data Element Submission Form

IC 259850 under ICR 202304-0955-001 · OMB 0955-0020.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 US Core Data for Interoperability (USCDI) New Data Element Submission Form	Form
1 USCDI Submission Form USCDI Revised Submission Form 4.17.23.docx	Form
1 USCDI Submission Form USCDI Revised Submission Form 4.17.23.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.5 (b)

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	USCDI Submission Form	USCDI Revised Submission Form 4.17.23.docx		Yes	No	Fillable Fileable

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	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.