Section 3013 State Health Information Exchange Cooperative Agreement Program: Full Application

Forms and Documents

Document	Type	Status	Availability
Form 1 Full Application Required Data Elements	Form and Instruction	Unchanged	Available
0990-0342 FOA_State Health Information Exchange Cooperative Agreement Program_Sept3proposedchanges (2).doc	Supplementary Document	Uploaded 2009-09-04	Available
0990-0342 Justification_FOArevisioon090409.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2009-09-04	Available
PRA Review for Emergency Request for 3013 Application 8.26.2009.doc	Supporting Statement A	Uploaded 2009-08-26	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
190468	Full Application Required Data Elements	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0990-0342	ICR Reference No: 200909-0990-001
Status: Historical Active	Previous ICR Reference No: 200908-0990-007
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Section 3013 State Health Information Exchange Cooperative Agreement Program: Full Application
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 08/28/2009
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/04/2009
	Date Received in OIRA: 09/04/2009
Terms of Clearance: This change request is approved, consistent with justification provided. Previous terms of clearance remain in effect.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2010	02/28/2010	02/28/2010
Responses	50	0	50
Time Burden (Hours)	14,000	0	14,000
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this program, as authorized by Section 3013 of the American Recovery and Reinvestment Act is to provide grants to States and Qualified State Designated Entities for planning and implementation of interoperable health information technology. The applications assist ONC in determining which States and State Designated Entities meet the requirements for award. Applicants are required to submit the information in attachment 1 that are associated with the application process so that ONC may make a determination about whether to award a cooperative agreement.

Emergency Justfication: The 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 8/28/09. 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.

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Authorizing Statute(s): US Code: 42 USC 3013 Name of Law: US Public Health Service 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

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
Full Application Required Data Elements	1	Attachment 1

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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	50	0	0	0	0
Annual Time Burden (Hours)	14,000	14,000	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: This is a new emergency data collection request.

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Annual Cost to Federal Government: $15,162

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: 09/04/2009

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