HRSA Electronic Health Record Readiness Assessment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form EHR readiness HRSA Electronic Health Record Readiness Assessment	Form and Instruction	Modified	Available
SS EHR ARRA CIP.doc	Supporting Statement A	Uploaded 2009-08-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
189033	HRSA Electronic Health Record Readiness Assessment	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0325	ICR Reference No: 200908-0915-004
Status: Historical Active	Previous ICR Reference No: 200905-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: HRSA Electronic Health Record Readiness Assessment
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/23/2009
	Date Received in OIRA: 08/31/2009
Terms of Clearance: This ICR is approved for 18 months. During that time, HRSA shall explicitly consider and seek comment on the merits of creating a separate information collection instrument to assess grantee process on meeting milestones regarding EHRs using objective criteria applied consistently across all grantees.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2011	36 Months From Approved	12/31/2009
Responses	568	0	568
Time Burden (Hours)	142	0	142
Cost Burden (Dollars)	0	0	0

---

Abstract: The Electronic Health Record checklist demonstrates readiness for electronic health records if applicants propose to use American Recovery and Reinvestment Act (ARRA) funds for electronic health record (EHR) related purchases. HRSA uses this information along with the overall application to determine eligibility for agency awards.

---

Authorizing Statute(s): PL: Pub.L. 111 - 5 2 Name of Law: American Recovery and Reinvestment Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 30298	06/25/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 42676	08/24/2009
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
HRSA Electronic Health Record Readiness Assessment	EHR readiness	EHR Readiness

---

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	568	568	0	0	0	0
Annual Time Burden (Hours)	142	142	0	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:

---

Annual Cost to Federal Government: $7,310

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)? Yes

Is this ICR related to the Pandemic Response? Uncollected

---

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: 08/31/2009

---