View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	NATIONAL ELECTRONIC HEALTH RECORDS SURVEY (NEHRS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Form and Instruction	n/a	2018 NEHRS Questionnaire	Att B - 2018 NEHRS Questionnaire 061418.pdf		No		Paper Only
Form and Instruction	n/a	CATI Option for the 2018 NEHRS Questionnaire	Att C - 2018 NEHRS CATI Script 061418.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0167 Health Resources Utilization Statistics	FR Citation: 49 FR 37693

Number of Respondents: 10,302	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 30 %

	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	10,302	0	0	0	0	10,302
Annual IC Time Burden (Hours)	5,151	0	0	0	0	5,151
Annual IC Cost Burden (Dollars)	0	0	0	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.