Information Collection

57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Initial Set up

IC 263465 under ICR 202410-0920-013 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.700 57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Initial Set up	Form and Instruction
57.700 Medication Safety-Digital Measure Reporting Plan (HYPO, 57.700 Initial Set-up.docx	Form and Instruction
57.700 Medication Safety-Digital Measure Reporting Plan (HYPO, 57.700 Initial Set-up.docx	Form and Instruction
57.700 Medication Safety Component Digital Reporting Plan-Clean Version.docx Form Information only	IC Document
57.700 Medication Safety Component Digital Reporting Plan-Clean Version.docx Form Information only	IC Document

IC Title:

57.700 - Medication Safety Component FHIR Measure-Glycemic Control Module Hypoglycemia-IT Initial Set up

Agency IC Tracking Number:

0920-0666

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	57.700	Medication Safety-Digital Measure Reporting Plan (HYPO, HAKI, ORAE) -IT Initial Set up	57.700 Initial Set-up.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,500

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	5,500	5,500
Annual IC Time Burden (Hours)	148,500	148,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Form Information only	57.700 Medication Safety Component Digital Reporting Plan-Clean Version.docx	11/04/2024

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