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Pretest Survey
Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Electronic Health Information Exchange
OMB: 0990-0398
IC ID: 202022
OMB.report
HHS/HHSDM
OMB 0990-0398
ICR 201204-0990-002
IC 202022
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0398 can be found here:
2012-08-08 - No material or nonsubstantive change to a currently approved collection
2012-08-02 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
0990- ONC-ConsumerSurvey.docx
Other-survey
HHS ONC ConsumerPrivacySurveyFinal5.2.docx
Other-Consumer Privacy Survey
ONCConsumerPrivacySurveyFinal05-02-2012.docx
Other-Consumer Privacy Survey
ONCConsumerPrivacySurveyFinalSpanish.docx
Other-Consumer Privacy Survey Spanis
0990-ONCConsumerPrivacySurvey Questionnaire Final6 19.docx
Other-Questionnaire
0990-ONCcunsumerBriefing Slides Cognitive Interviews_022912.pptx
Other-Slides
ONCConsumerPrivacySurveyIntroScript.docx
ONCConsumerPrivacySurveyIntroScript
IC Document
ONCConsumerPrivacySurveyIntroScriptSpanish.docx
ONCConsumerPrivacySurveyIntroScriptSpanish
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Pretest Survey
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
Other-Consumer Privacy Survey
ONCConsumerPrivacySurveyFinal05-02-2012.docx
Yes
Yes
Printable Only
Other-Questionnaire
0990-ONCConsumerPrivacySurvey Questionnaire Final6 19.docx
Yes
Yes
Printable Only
Other-Slides
0990-ONCcunsumerBriefing Slides Cognitive Interviews_022912.pptx
Yes
Yes
Printable Only
Other-survey
0990- ONC-ConsumerSurvey.docx
Yes
Yes
Printable Only
Other-Consumer Privacy Survey Spanish
ONCConsumerPrivacySurveyFinalSpanish.docx
Yes
Yes
Printable Only
Other-Consumer Privacy Survey
HHS ONC ConsumerPrivacySurveyFinal5.2.docx
Yes
Yes
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
33
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
33
0
33
0
0
0
Annual IC Time Burden (Hours)
8
0
8
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
ONCConsumerPrivacySurveyIntroScript
ONCConsumerPrivacySurveyIntroScript.docx
05/15/2012
ONCConsumerPrivacySurveyIntroScriptSpanish
ONCConsumerPrivacySurveyIntroScriptSpanish.docx
05/15/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.