OMB control number

Access, Exchange, And Use Of Social Determinants Of Health Data In Clinical Notes

OMB 0955-0021 · HHS/ONC.

OMB 0955-0021

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form C3 Synchronous Focus Group Questions for Clinicians and Healthcare Professionals	Form
Form C5 Synchronous Focus Group Questions for Patients and Care Partners (Spanish)	Form
Form B3 Prescreening Questionnaire for Patients and Care Partners (Spanish)	Form
Form C1 Asynchronous Focus Group Questions for Clinicians and Healthcare Professionals	Form
Form C4 Synchronous Focus Group Questions for Patients and Care Partners	Form
Form C2 Asynchronous Focus Group Questions for Patients and Care Partners	Form
Form B1 Prescreening Questionnaire for Clinicians and Healthcare Professionals	Form
Form B2 Prescreening Questionnaire for Patients and Care Partners	Form
Final Supporting Statement A 10-28-2021.docx	Supporting Statement A
Attachment D5. Final Synchronous Focus Group Consent-Patients and Care Partners (English).docx	Supplementary Document
Attachment D4. Final Synchronous Focus Group Consent-Patient and Care Partners (Spanish).docx	Supplementary Document
Attachment D3. Final Synchronous Focus Group Consent-Clinicians and Healthcare Professionals.docx	Supplementary Document
Attachment D1. Final Asynchronous Focus Group Consent-Clinicians and Healthcare Professionals.docx	Supplementary Document
Attachment D2. Final Asynchronous Focus Group Consent-Patients and Care Partners.docx	Supplementary Document
Final Supporting Statement B 8.9.21.docx	Supporting Statement B
Synchronous Focus Group Questions for Clinicians and Healthcare Professionals	Form
Synchronous Focus Group Questions for Patients and Care Partners (Spanish)	Form
Prescreening Questionnaire for Patients and Care Partners (Spanish)	Form
Asynchronous Focus Group Questions for Clinicians and Healthcare Professionals	Form
Synchronous Focus Group Questions for Patients and Care Partners	Form
Asynchronous Focus Group Questions for Patients and Care Partners	Form
Prescreening Questionnaire for Clinicians and Healthcare Professionals	Form
Prescreening Questionnaire for Patients and Care Partners	Form

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
202103-0955-002	New collection (Request for a new OMB Control Number)	2021-10-28		Approved with change