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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: 0955-0001
IC ID: 202022
OMB.report
HHS/ONC
OMB 0955-0001
ICR 201309-0955-001
IC 202022
( )
Documents and Forms
Document Name
Document Type
0990- ONC-ConsumerSurvey.docx
Other-survey
ONCConsumerPrivacySurveyFinalSpanish.docx
Other-Consumer Privacy Survey Spanis
ONCConsumerPrivacySurveyFinal05-02-2012.docx
Other-Consumer Privacy Survey
0990-ONCcunsumerBriefing Slides Cognitive Interviews_022912.pptx
Other-ConsumerBriefing Slides Cognit
0990-ONCConsumerPrivacySurvey Questionnaire Final6 19.docx
Other-ONCConsumerPrivacySurvey Quest
ONCConsumerPrivacySurveyIntroScriptSpanish.docx
ONCConsumerPrivacySurveyIntroScriptSpanish
IC Document
ONCConsumerPrivacySurveyIntroScript.docx
ONCConsumerPrivacySurveyIntroScript
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:
Modified
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-survey
0990- ONC-ConsumerSurvey.docx
Yes
Yes
Printable Only
Other-Consumer Privacy Survey Spanish
ONCConsumerPrivacySurveyFinalSpanish.docx
Yes
Yes
Printable Only
Other-Consumer Privacy Survey
ONCConsumerPrivacySurveyFinal05-02-2012.docx
Yes
Yes
Printable Only
Other-ConsumerBriefing Slides Cognitive Interviews_022912
0990-ONCcunsumerBriefing Slides Cognitive Interviews_022912.pptx
Yes
No
Printable Only
Other-ONCConsumerPrivacySurvey Questionnaire Final6 19
0990-ONCConsumerPrivacySurvey Questionnaire Final6 19.docx
Yes
No
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
0
0
0
33
Annual IC Time Burden (Hours)
8
0
0
0
0
8
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
ONCConsumerPrivacySurveyIntroScriptSpanish
ONCConsumerPrivacySurveyIntroScriptSpanish.docx
05/15/2012
ONCConsumerPrivacySurveyIntroScript
ONCConsumerPrivacySurveyIntroScript.docx
05/15/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.