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Electronic patient record review
Health Care Systems for Tracking Colorectal Cancer Screening Tests
OMB: 0935-0146
IC ID: 185934
OMB.report
HHS/AHRQ
OMB 0935-0146
ICR 200807-0935-002
IC 185934
( )
Documents and Forms
Document Name
Document Type
Form Form #1
Electronic patient record review
Form and Instruction
Form #1 Electronic patient record review
Attachment C7_Electronic Records Review Eligibility Criteria.xls
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Electronic patient record review
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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
Form #1
Electronic patient record review
Attachment C7_Electronic Records Review Eligibility Criteria.xls
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4
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:
0 %
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
12
0
12
0
0
0
Annual IC Time Burden (Hours)
68
0
68
0
0
0
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.