OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

[OPHDST] Health Data Utilities (HDU)/Health Information Exchange (HIE) Listening Session

IC 277714 under ICR 202506-0920-002 · OMB 0920-1050.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 0920-1050
HDU/HIE Invitation Email and Listening Session Guide [OPHDST] Health Data Utilities (HDU)/Health Information Exchange (HIE) Listening Session		 Form and Instruction
0920-1050 HDU/HIE Invitation Email and Listening Session Guide
HDU HIE Invitation Email.docx 		Form and Instruction
HDU HIE SSA New Requirements.docx
0920-1050 SSA - Summary		IC Document
HDU HIE SSA GenIC Template.docx
0920-1050 GenIC Request Memo 24SEP2025		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 0920-1050 N/A No   Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 50 0 50 0 0 0
Annual IC Time Burden (Hours) 38 0 38 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
0920-1050 SSA - Summary 09/24/2025
0920-1050 GenIC Request Memo 24SEP2025 09/24/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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