Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10175 ELECTRONIC FILE INTERCHANGE ORGANIZATION (EFIO) CERTIFICATION STATEMENT	Form and Instruction	Modified	Available
CMS-10175.REVISED - Supp State Pt A - CLEAN-9-11-09.doc	Supporting Statement A	Uploaded 2009-09-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43676	Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System	Form and Instruction	Modified	ELECTRONIC FILE INTERCHANGE ORGANIZATION (EFIO) CERTIFICATION STATEMENT

ICR Details

OMB Control No: 0938-0984	ICR Reference No: 200904-0938-010
Status: Historical Active	Previous ICR Reference No: 200703-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/15/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/22/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2012	36 Months From Approved
Responses	100	0	0
Time Burden (Hours)	300	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The EFI process allows provider-designated organizations (EFIOs) to capture multiple providers' NPI application information on a single file. To ensure that the EFIO has the authority to act on behalf of the each provider and complies with other Federal requirements, the EFIO must sign a certification statement and mail it to CMS. Most EFIOs will be entities that employ or represent large number of medical providers.

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Authorizing Statute(s): PL: Pub.L. 104 - 191 Title II Name of Law: Health Insurance Portability and Accountability Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 60296	10/10/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 15272	04/03/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System	CMS-10175	ELECTRONIC FILE INTERCHANGE ORGANIZATION (EFIO) CERTIFICATION STATEMENT

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ICR Summary of Burden

table that charts list 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	100	0	0	0	-900	1,000
Annual Time Burden (Hours)	300	0	0	0	-2,700	3,000
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: Due to the fact that the majority of health care providers utilize the National Plan and Provider Enumeration System (NPPES) web application in order to obtain their NPIs or submit updates/changes to their existing NPPES data and most existing providers now have their NPIs, the burden associated with the Electronic File Interchange Organizations (EFIOs) certification statement (CMS-10175) has significantly decreased. In addition, the majority of organizations that would likely ever be EFIOs have already registered, completed the certification statement and are approved to submit EFI files; therefore, the number of respondents have greatly decreased. The EFIO certification statement form (CMS-10175) is still required for new EFIOs who wish to submit EFI files on behalf of health care providers who wish to obtain NPIs or wish to have an EFIO submit updates/changes on their behalf.

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Annual Cost to Federal Government: $45,000

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 04/22/2009

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