Information Collection

57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-IT Initial Set up

IC 263450 under ICR 202603-0920-006 · OMB 0920-0666.

Documents and Forms

Document Name Document Type
57.132 Initial Set-up.docx Other-OMB Header and Burden Statemen

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.132 - Patient Safety Component FHIR Measures-HOB, HT-CDI Modules-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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-OMB Header and Burden Statement			57.132 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: 4,980	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 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,980	-520	5,500
Annual IC Time Burden (Hours)	124,500	-24,000	148,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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

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