Electronic Health Record Demonstration

ICR 200806-0938-007

OMB: 0938-0965

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2008-06-17
Supplementary Document
2008-02-20
IC Document Collections
ICR Details
0938-0965 200806-0938-007
Historical Active 200803-0938-001
HHS/CMS
Electronic Health Record Demonstration
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 08/01/2008
Retrieve Notice of Action (NOA) 06/26/2008
  Inventory as of this Action Requested Previously Approved
06/30/2011 06/30/2011 06/30/2011
2,400 0 2,400
520 0 520
0 0 0

Electronic Health Record demonstration. This demonstration is a high-priority Administration of this initiative. The purpose of this demonstration project is to reward the delivery of high-quality care supported by the adoption and use of electronic health records in small to medium-sized primary care physician practices. While this initiative is separate and distinct from the Medicare Care Management Performance (MCMP) Demonstration, it expands upon the foundation created by the MCMP Demonstration, which was mandated by Section 649 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. The electronic health record demonstration will be operational for a 5-year period and will be operated under section 402 demonstration waiver authority. The information to be obtained as part of the application form is necessary to document basic information for physician practices that intend to participate in this demonstration initiative. This information will be used to establish that the practices meet basic eligibility requirements for participation in this initiative. The application form requests basic physician office information (e.g., number of physicians in the practice, specialties, organizational structure, Medicare Provider Identification Number, tax identification number, contact information, etc. Practices that apply will be expected to sign a data sharing consent form that will accompany the form. It is expected that up to 2,400 application forms will be submitted by physician practices in 12 states for subsequent randomization to treatment and control groups.

PL: Pub.L. 108 - 173 649 Name of Law: Medicare Care Management Performance (MCMP) Demonstration
  
None

Not associated with rulemaking

  72 FR 67605 11/29/2007
73 FR 8877 02/15/2008
Yes

  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 2,400 2,400 0 0 0 0
Annual Time Burden (Hours) 520 520 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$312,000
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Bonnie Harkless 4107865666

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/26/2008


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