Information Collection

EHR for Visit Data (quarterly) (2024)

IC 247678 under ICR 202412-0920-002 · OMB 0920-0234.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0234 EHR for Visit Data (quarterly) (2024)	Form and Instruction
Form 0920-0234 NAMCS Electronic Health Record (EHR): Pulling and Sending Records EHR for Visit Data (quarterly) (2024)	Form and Instruction
Form 0920-0234 National Health Care Surveys Release 1 EHR for Visit Data (quarterly) (2024)	Form and Instruction
Form 0920-0234 HL7 CDA® R2 Implementation Guide: National Health Care Surveys Release 1, EHR for Visit Data (quarterly) (2024)	Form and Instruction
0920-0234 NAMCS Electronic Health Record (EHR): Pulling and Sendin Attachment O_NAMCS EHR Record Pulling Burden.docx	Form and Instruction
0920-0234 NAMCS Electronic Health Record (EHR): Pulling and Sendin Attachment O_NAMCS EHR Record Pulling Burden.docx	Form and Instruction
0920-0234 National Health Care Surveys Release 1 Attachment I_EHR Implementation guide templates.pdf	Form and Instruction
0920-0234 National Health Care Surveys Release 1 Attachment I_EHR Implementation guide templates.pdf	Form and Instruction
0920-0234 HL7 CDA® R2 Implementation Guide: National Health Care S Attachment H_EHR Implementation guide.pdf	Form and Instruction
0920-0234 HL7 CDA® R2 Implementation Guide: National Health Care S Attachment H_EHR Implementation guide.pdf	Form and Instruction
Attachment G_Electronic Health Record (EHR) Variable List.xlsx Electronic Health Record Variable List	IC Document
Attachment G_Electronic Health Record (EHR) Variable List.xlsx Electronic Health Record Variable List	IC Document

IC Title:

Agency IC Tracking Number:

0920-0234

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0234	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0234	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0234	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

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	200	68	132
Annual IC Time Burden (Hours)	200	68	132
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Electronic Health Record Variable List		12/20/2024

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

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