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[NCHHSTP] TRANSCEND: Transgender Status-neutral Community-to-clinic Models to End the HIV Epidemic
OMB: 0920-1410
IC ID: 260395
OMB.report
HHS/CDC
OMB 0920-1410
ICR 202305-0920-002
IC 260395
( )
Documents and Forms
Document Name
Document Type
Att3c_EHR.docx
Other-Specification of Data Elements
Att3c_EHR.docx
Other-Specification of Data Elements
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Electronic Health Record Data
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Specification of Data Elements for Electronic Transfer
Att3c_EHR.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
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:
100 %
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
8
0
8
0
0
0
Annual IC Time Burden (Hours)
64
0
64
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.