State Medicaid HIT Plan (SMHP) and Template for Implementation of Section 4201 of ARRA (CMS-10292)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10292 (IAPD) Implementation Advanced Planning Document (IAPD) Template	Form and Instruction	Modified	Available
Form CMS-10292 (HIT P-A Model Checklist: HIT Planning-Advance Planning Document (HIT P-APD)	Form and Instruction	Modified	Available
Form CMS-10292 (SMHP) State Medicaid HIT Plan (SMHP)	Form and Instruction	Modified	Available
CMS-10292 Supporting Statement part A [rev 08-09-11].doc	Supporting Statement A	Uploaded 2011-08-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192702	State Medicaid HIT Plan (SMHP) and Template for Implementation of Section 4201 of ARRA (CMS-10292)	Form and Instruction	Modified	Implementation Advanced Planning Document (IAPD) Template
192702	State Medicaid HIT Plan (SMHP) and Template for Implementation of Section 4201 of ARRA (CMS-10292)	Form and Instruction	Modified	Model Checklist: HIT Planning-Advance Planning Document (HIT P-APD)
192702	State Medicaid HIT Plan (SMHP) and Template for Implementation of Section 4201 of ARRA (CMS-10292)	Form and Instruction	Modified	State Medicaid HIT Plan (SMHP)

ICR Details

OMB Control No: 0938-1088	ICR Reference No: 201108-0938-002
Status: Historical Active	Previous ICR Reference No: 201103-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: State Medicaid HIT Plan (SMHP) and Template for Implementation of Section 4201 of ARRA (CMS-10292)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/23/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/16/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	36 Months From Approved	04/30/2014
Responses	56	0	56
Time Burden (Hours)	896	0	280
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection is being requested in order that States can submit documentation to CMS for review and approval in order that States can implement the Medicaid program and draw down Federal financial participation. The American Reinvestment and Recovery Act of 2009 provides States with the flexibility to request funds to develop a health information technology vision and road to get to the ultimate goal of meaningful use of certified EHR technology. We will be sending State Medicaid Directors letters and templates for the SMHP, the PAPD and IAPD to States in an effort to request these changes, if they so choose and to make the process as simple as possible. These documents will be collections of data and therefore, the need for this information request.

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Authorizing Statute(s): PL: Pub.L. 111 - 5 4201 Name of Law: American Reinvestment and Recovery Act of 2009
  

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:
	76 FR 28791	05/18/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 47592	08/05/2011
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
State Medicaid HIT Plan (SMHP) and Template for Implementation of Section 4201 of ARRA (CMS-10292)	CMS-10292 (SMHP), CMS-10292 (HIT P-APD), CMS-10292 (IAPD)	State Medicaid HIT Plan (SMHP) ,   Model Checklist: HIT Planning-Advance Planning Document (HIT P-APD) ,   Implementation Advanced Planning Document (IAPD) Template

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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	56	56	0	0	0	0
Annual Time Burden (Hours)	896	280	0	616	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: The annual hour burden has increased from 280 hr to 896 hr based on the addition of the IAPD template.

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Annual Cost to Federal Government: $13,776

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 08/16/2011

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