OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

EHR for Visit Data (quarterly) (Survey year: 2025-2027)_ACP staff

IC 256555 under ICR 202412-0920-002 · OMB 0920-0234.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

EHR for Visit Data (quarterly) (Survey year: 2025-2027)_ACP staff 0920-0234
 
Yes Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0234 EHR Implementation Guide Templates Attachment I_EHR Implementation guide templates.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-0234 Attachment O2_NAMCS EHR Record Pulling Burden Attachment H_EHR Implementation guide.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

3,000 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 12,000 0 0 0 0 12,000
Annual IC Time Burden (Hours) 12,000 0 0 0 0 12,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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