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View Information Collection (IC) List
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-1278
ICR Reference No:
201510-0938-005
Status:
Historical Active
Previous ICR Reference No:
201504-0938-008
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Electronic Health Record Incentive Program-Stage 3 (CMS-10552)
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
12/23/2016
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/30/2015
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2019
36 Months From Approved
Responses
641,494
0
0
Time Burden (Hours)
4,230,155
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
The Centers for Medicare and Medicaid Services is requesting approval to collect information from eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs) in order to implement requirements under Stage 3 of the Medicare and Medicaid EHR Incentive Programs.
Authorizing Statute(s):
PL:
Pub.L. 111 - 5 Title IV of Division B
Name of Law: The American Recovery and Reinvestment Act of 2009
PL:
Pub.L. 111 - 5 Title XIII of Division A
Name of Law: The American Recovery and Reinvestment Act of 2009
Citations for New Statutory Requirements:
PL: Pub.L. 111 - 5 Title IV of Division B Name of Law: The American Recovery and Reinvestment Act of 2009
PL: Pub.L. 111 - 5 Title XIII of Division A Name of Law: The American Recovery and Reinvestment Act of 2009
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AS26
Final or interim final rulemaking
80 FR 62762
10/16/2015
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
5
IC Title
Form No.
Form Name
§ 495.24-Objectives/Measures (EPs)
§495.210 - Gather information for attestation (MA EPs)
§495.210 –Attestation on behalf of MA EPs
§495.24 Objectives/Measures (hospitals/CAHs)
§495.316 – Quarterly Reporting
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
641,494
0
641,494
0
0
0
Annual Time Burden (Hours)
4,230,155
0
4,230,155
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This is a new information collection request.
Annual Cost to Federal Government:
$10,000,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Yes
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
William Parham 4107864669
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
10/30/2015
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