National Survey of Health Information Exchange Organizations (HIO)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0955-0019 can be found here:

Documents and Forms

Document Name Document Type
Form 0000 National Survey of Health Information Exchange Organizations (HIO) Form and Instruction
0000 National Survey of Health Information Exchange Organizat 2018 HIE Survey.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	National Survey of Health Information Exchange Organizations (HIO)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.8(d)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0000	National Survey of Health Information Exchange Organizations	2018 HIE Survey.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	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.