National Survey of Health Information Exchange Organizations (HIO)

Documents and Forms

Document Name Document Type
0955-0019 HIO Survey Instrument_CLEAN wBurden Statement & OMB#.docx Other-Survey
0955-0019 HIO Survey Instrument_MARK-UP.docx 0955-0019 HIO Survey Instrument MARK UP IC Document

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: Modified

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
Other-Survey			0955-0019 HIO Survey Instrument_CLEAN wBurden Statement & OMB#.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	-5	105
Annual IC Time Burden (Hours)	75	-4	79
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
0955-0019 HIO Survey Instrument MARK UP	0955-0019 HIO Survey Instrument_MARK-UP.docx	08/08/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.