Information Collection

National Survey of Health Information Exchange Organizations (HIO)

IC 233372 under ICR 202408-0955-001 · OMB 0955-0019.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0955-0019 HIO Survey Instrument_CLEAN wBurden Statement & OMB#.docx	Other-Survey
0955-0019 HIO Survey Instrument_CLEAN wBurden Statement & OMB#.docx	Other-Survey
0955-0019 HIO Survey Instrument_MARK-UP.docx 0955-0019 HIO Survey Instrument MARK UP	IC Document
0955-0019 HIO Survey Instrument_MARK-UP.docx 0955-0019 HIO Survey Instrument MARK UP	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.8(d)

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					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	-5	105
Annual IC Time Burden (Hours)	75	-4	79
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0955-0019 HIO Survey Instrument MARK UP		08/08/2024

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

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