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Military Health System Electronic Health Record End User Survey
Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0704-0553
IC ID: 253193
OMB.report
DOD/DODDEP
OMB 0704-0553
ICR 202505-0704-008
IC 253193
( )
Documents and Forms
Document Name
Document Type
MAX Survey - Military Health System Electronic Health Record End User Su.._.pdf
Other-Survey
One-Pager_EHR End User Survey_4.15.22.docx
One-Pager MHS Electronic Health Record End User Survey
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Military Health System Electronic Health Record End User Survey
Agency IC Tracking Number:
IC Status:
Removed
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Survey
MAX Survey - Military Health System Electronic Health Record End User Su.._.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Defense and National Security
Subfunction:
Operational Defense
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
0
0
-2,500
0
0
2,500
Annual IC Time Burden (Hours)
0
0
-417
0
0
417
Annual IC Cost Burden (Dollars)
0
0
-3,125
0
0
3,125
Documents for IC
Title
Document
Date Uploaded
One-Pager MHS Electronic Health Record End User Survey
One-Pager_EHR End User Survey_4.15.22.docx
05/03/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.