ARRA Section 3013 Supporting Statement for State Health Information Exchange Cooperative Agreement Program

Forms and Documents

Document Name	Status
Form 1 Letter of Intent Form	New
3013 PRA SS A.doc Supporting Statement A	2009-08-19

IC Document Collections

IC ID	Document Title	Status
190358	Letter of Intent Form	New

ICR Details

OMB Control No: 0990-0339	ICR Reference No: 200908-0990-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: ARRA Section 3013 Supporting Statement for State Health Information Exchange Cooperative Agreement Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 08/20/2009
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/20/2009
	Date Received in OIRA: 08/19/2009
Terms of Clearance: This information collection request is approved for six months on an emergency basis. When the collection is made available to the public, ONC will ensure that the OMB control number for this collection, along with the expiration date and the statutorily-mandated PRA burden statement are added to the request document. OMB looks forward to continuing to work with ONC to ensure PRA compliance for the suite of materials associated with this initiative. This includes all application materials, to be submitted for approval right away and post-award reporting, which will be submitted separately.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2010	6 Months From Approved
Responses	50	0	0
Time Burden (Hours)	500	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The data collected will be used to help established state cooperative agreements to promote health information technology planning and implementation projects to advance appropriate and secure health information exchange (HIE) across the health care system. Awards will be made in the form of cooperative agreements to states or qualified State Designated Entities (SDEs). The purpose of this program is to continuously improve and expand HIE services over time to reach all health care providers in an effort to improve the quality and efficiency of health care. Cooperative agreement recipients will evolve and advance the necessary governance, policies, technical services, business operations and financing mechanisms for HIE over a four year performance period. This program will build off of existing efforts to advance regional and state level HIE while moving towards nationwide interoperability. Applicants are required to submit a letter of intent to apply for this funding opportunity to assist ONC in planning for the independent review process. This letter will be submitted by the state or State Designated Entity that will act as the applicant on behalf of all states involved in the proposed project.

Emergency Justfication: The Department of Health and Human Services Office of National Coordinator for Health Information Technology (ONC) is requesting emergency action for this clearance by the Office of Management and Budget no later than 8/20/09. ONC is requesting emergency processing procedures for this application because this information is needed immediately to assure that ARRA funds are used timely and effectively to support electronic health record adoption which will improve the health care and quality. This funding opportunity needs to be made available as soon as possible because they are part of the fiscal stimulus initiative. Moreover, the Vice President would like to announce these opportunities very soon.

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Authorizing Statute(s): None

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

Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Letter of Intent	1	LOI

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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	50	0	0	50	0	0
Annual Time Burden (Hours)	500	0	0	500	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new emergency information request.

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Annual Cost to Federal Government: $0

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

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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: 08/19/2009

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