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

Document Name
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All Historical Document Collections

202103-0955-002

Approved with change

New collection (Request for a new OMB Control Number)

2021-10-28