Electronic Records Express

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Addendum 0753.doc	Supplementary Document	Uploaded 2012-03-15	Available
0753 Supporting Statement(revised).doc	Supporting Statement A	Uploaded 2012-06-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
189280	Functionality for Electronic Medical Provide Reimbursement Requests	Other-Elctronic Payment Request Screens	Removed
180253	ERE	Other-Sreen shots	Modified

ICR Details

OMB Control No: 0960-0753	ICR Reference No: 201202-0960-003
Status: Historical Active	Previous ICR Reference No: 200905-0960-015
Agency/Subagency: SSA	Agency Tracking No:
Title: Electronic Records Express
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: 08/31/2012
	Date Received in OIRA: 06/15/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2015	36 Months From Approved	09/30/2012
Responses	3,552,176	0	17,689
Time Burden (Hours)	592,029	0	2,949
Cost Burden (Dollars)	0	0	0

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Abstract: Electronic Records Express (ERE) is a web-based SSA program medical providers and others use to electronically submit disability claim data to SSA. This ICR includes 1) the registration process for ERE and 2) a new functionality that allows medical providers to electronically submit reimbursement requests to SSA. The respondents are new ERE users and medical providers who are current ERE users.

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Authorizing Statute(s): PL: Pub.L. 105 - 277 - Name of Law: Government Paperwork Elimination Act
  

Citations for New Statutory Requirements: PL: Pub.L. 105 - 277 - Name of Law: Government Paperwork Elimination Act

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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:
	77 FR 13681	03/07/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 35739	06/14/2012
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
ERE
Functionality for Electronic Medical Provide Reimbursement Requests

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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	3,552,176	17,689	0	-13,000	3,547,487	0
Annual Time Burden (Hours)	592,029	2,949	0	-2,167	591,247	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There has been a decrease in burden hours, because the actual burden for uploading medical evidence is now covered under a OMB No. 0960-0555 (Clearance of Information Collections Conducted by State Disability Determination Services on Behalf of SSA). There has been an increase in burden hours. When we cleared the package in 2009, our numbers were estimates; we now base the increase in burden hours off current figures.

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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]? 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)? 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: 06/15/2012

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