2024-21573. Proposed Data Collection Submitted for Public Comment and Recommendations

Estimated Annualized Burden Hours

Type of respondents	Form name	Number of respondents	Number of responses per respondent	Avg. burden per response (in hrs.)	Total burden (in hrs.)
HC's Staff	HC Facility Interview Questionnaire (Survey year: 2024)	84	1	45/60	63
	Prepare and transmit EHR for Visit Data (quarterly) (Survey year: 2024)	50	4	60/60	200
	Set-up Fee Questionnaire (Survey year: 2024)	17	1	15/60	4
Provider or Staff	ACPI (Survey year: 2026)	3,333	1	30/60	1,667
	Contact Tracing (Survey year: 2026)	3,333	1	10/60	556
Advanced Practice Provider or Staff	ACPI (Survey year: 2025 & 2027)	6,667	1	30/60	3,334
	Contact Tracing (Survey year: 2025 & 2027)	6,667	1	10/60	1,111
Ambulatory Care Provider's or Group's or Conglomerate's Staff	PFI (Survey year: 2025-2027) Prepare and transmit Electronic Visit Data (quarterly) (Survey year: 2025-2027)	3,000 3,000	1 4	45/60 60/60	2,250 12,000
HC's Staff	HC Facility Interview Questionnaire (Survey year: 2025-2027)	221	1	45/60	166
	Prepare and transmit EHR for Visit Data (quarterly) (Survey year: 2025-2027)	188	4	60/60	752
	Set-up Fee Questionnaire (Survey year: 2025-2027)	17	1	15/60	4
Total					22,107