Electronic Health Record Data

[NCHHSTP] TRANSCEND: Transgender Status-neutral Community-to-clinic Models to End the HIV Epidemic

OMB: 0920-1410

IC ID: 260395

Documents and Forms
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Other-Specification of Data Elements
Other-Specification of Data Elements
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Electronic Health Record Data
 
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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

Health Illness Prevention

 

4 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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

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