Information Collection

2027 Health Information Organization (HIO) Survey

IC 282351 under ICR 202609-0955-001 · OMB 0955-0019.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0955-0019 2027 HIO Survey Instrument_clean.docx	Other-Survey
0955-0019 2027 HIO Survey Instrument_redline.docx 2027 HIO Survey Instrument Redlined 0955-0019	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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
Other-Survey					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 85

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	85	85
Annual IC Time Burden (Hours)	85	85
Annual IC Cost Burden (Dollars)	11,019	11,019

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2027 HIO Survey Instrument Redlined 0955-0019		09/08/2026

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

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