System Redesign for Value in Safety Net Hospitals and Delivery Systems

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #2 Collection of documentation	Form and Instruction	New	Available
Form Form #1 In-person interviews	Form	New	Available
Supporting Statement B -- System Redesign for Value in Safety Net Hospitals and Delivery Systems.doc	Supporting Statement B	Uploaded 2012-05-01	Available
Attachment D - Informed Consent Form.doc	Supplementary Document	Uploaded 2012-05-01	Available
Attachment C -- Federal Register Notice.pdf	Supplementary Document	Uploaded 2012-05-01	Available
Supporting Statement A -- System Redesign for Value in Safety Net Hospitals and Delivery Systems.doc	Supporting Statement A	Uploaded 2012-05-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202150	Collection of documentation	Form and Instruction	New
202149	In-person interviews	Form	New

ICR Details

OMB Control No: 0935-0198	ICR Reference No: 201205-0935-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: System Redesign for Value in Safety Net Hospitals and Delivery Systems
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/22/2012
	Date Received in OIRA: 05/04/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2015	36 Months From Approved
Responses	168	0	0
Time Burden (Hours)	176	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This proposed project is a case study of 8 safety net (SN) hospitals. The goals of the project are to: 1) identify the tools and resources needed to facilitate system redesign in SN hospitals and; 2) identify any barriers to adoption of these in SN environments, or any gaps that exist in the available resources. These goals are consistent with The National Strategy for Quality Improvement in Health Care, published by the US Department of Health and Human Services in March 2011, which articulated a need for progress toward three goals: 1) Better Care, 2) Healthy People/Healthy Communities and 3) Affordable Care. SN hospitals and systems are critical to achieving all three. SN hospitals are hospitals and health systems which provide a significant portion of their services to vulnerable, uninsured and Medicare patients. While all hospitals face challenges in improving both quality and operating efficiency, safety net (SN) hospitals face even greater challenges due to growing demand for their services and decreasing funding opportunities.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

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:
	77 FR 11117	02/24/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 24955	04/26/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Collection of documentation	Form #2	Collection of documentation guide
In-person interviews	Form #1	Interview guide

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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	168	0	0	168	0	0
Annual Time Burden (Hours)	176	0	0	176	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 proposed information collection request.

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Annual Cost to Federal Government: $166,626

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 05/04/2012

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