Information Collection

Att S_Quarterly Transmission of EHR Data

IC 186285 under ICR 202407-0920-002 · OMB 0920-0212.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0212 Att S_Quarterly Transmission of EHR Data	Form and Instruction
0920-0212 Quarterly Transmission of EHR Data Att S - Qtr Data Trans of EHR Data.docx	Form and Instruction
0920-0212 Quarterly Transmission of EHR Data Att S - Qtr Data Trans of EHR Data.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-0212

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	0920-0212	Quarterly Transmission of EHR Data	Att S - Qtr Data Trans of EHR Data.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0167 Health Resources Utilization Statistics

FR Citation: 49 FR 37693

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	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	800	800
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.