PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET
Part II: Information Collection Detail
This template is intended for staff without an ICRAS account. Please fill out and submit to the appropriate Operating Division to enter into ICRAS. The form mirrors the screens available in the ICRAS 4 system. To request an account to log into ICRAS.
Instructions for filling out the form are available at www.paperworkreduction.gov. |
|
||||||||||||||||||||||||||||||||||||||||||||||||||
1. Title Physician Quality Reporting System and Electronic Prescribing (E-Prescribing) Incentive Program – Registry Self-nomination (2010 & 2011)
|
||||||||||||||||||||||||||||||||||||||||||||||||||
2. Is this a Common Form? |
3. Obligation to respond (check one) |
4. Frequency of reporting (check all that apply) |
||||||||||||||||||||||||||||||||||||||||||||||||
Yes
x No |
a. x Voluntary
b. Required to obtain or retain benefits
c. Mandatory |
a. Hourly (24 -7) b. __ Hourly Bus (40 per week) c. Daily (7 per week) d. Daily Bus (5 per week) e. Weekly (52 per year) f. Monthly g. x Yearly h. Every Decade i. Quarterly j. Semi-annually k. Biennially l._ __ Once m. _ __ occasionally |
||||||||||||||||||||||||||||||||||||||||||||||||
Title _42_____ Part _____414____________ Section__________90______________ Title _42______ Part ____414______________ Section________92________________ Title _______ Part __________________ Section________________________ Title _______ Part __________________ Section________________________
|
||||||||||||||||||||||||||||||||||||||||||||||||||
6. Information Collection Instruments – Send all instruments along with the Part 2 form(s). If more than one Part 2 is completed make sure to identify which instruments are associated with which Part 2 form.
|
||||||||||||||||||||||||||||||||||||||||||||||||||
7. Federal Enterprise Architecture Business Reference Model (Select one Services for Citizens Line of Business and one Subfunction from its group)
See http://www.feapmo.gov for the Business Reference Model categories and definitions. |
||||||||||||||||||||||||||||||||||||||||||||||||||
8. Privacy Act System of Records (if applicable)
Title:
Performance Measurement and Reporting System
Federal Register Citation: Volume _72_______ Page number __52133__________ Publication date 09 / 12 /_07___
|
||||||||||||||||||||||||||||||||||||||||||||||||||
9. Respondents |
|
|
|
|
|
|
||||||||||||||||||||||||||||||||||||||||||||
a. Total # 50 b. Small Entity # 0 _________ c. Percent Electronic 100% ____________
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||
10. Frequency: How often on average will each respondent respond to the Information Collection? Number of Responses per Respondent ___1 Per (select the most appropriate time period for this collection) a. Hour (24-7) - 8736 per year b. Business Hour (40 per week) - 2080 per year c. Day (7 per week) - 364 per year d. Business Day (5 per week) - 260 per year e. Week - 52 per year f. Month - 12 per year g. x Year h. Decade .1 per year i. Quarter - 4 per year j. Half-Year - 2 per year k. Biennial - 0.5 per year l._ __ Once m. _ __ occasionally |
||||||||||||||||||||||||||||||||||||||||||||||||||
Calculated:
Annual Frequency =___1______________
times a year (per respondent) |
||||||||||||||||||||||||||||||||||||||||||||||||||
Calculated:
Annual Number Of Responses = _50
a
year |
||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||
|
11.
Hour and Cost Burden Enter the hours and cost (per response) broken out by reporting, record keeping, and third-party disclosure.
|
|||||
|
Time per Response |
Hour per response |
Annual Hour Burden |
Cost per Response |
Annual cost Burden |
Reporting |
10 hours |
10 hours |
500 hours |
$400 |
$20,000 |
Record keeping |
|
|
|
|
|
Third party disclosure |
|
|
|
|
|
Total |
10 hours |
10 hours |
500 hours |
$400 |
$20,000 |
|
Allocate the change in burden
|
Total Requested |
Change Due to New Statute |
Change Due to Agency Discretion |
Due to Agency Estimate |
Change Due Violation |
Currently Approved
|
a. Annual Responses |
50 |
|
50 |
|
|
|
b. Annual Hour Burden |
500 hours |
hours |
500 hours |
hours |
hours |
hours |
c. Annual Cost Burden |
$20,000
|
$ |
$20,000 |
$ |
$ |
$ |
The changes are due to the following:
A decrease in labor cost from $58/hour in 2011 to $40/hour in 2012.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | PAPERWORK REDUCTION ACT SUBMISSION WORKSHEET |
Author | USER |
File Modified | 0000-00-00 |
File Created | 2021-01-30 |