Information Collection Request

Medicare and Medicaid Programs; Electronic Health Record Incentive Program

ICR 201309-0938-017 · OMB 0938-1158 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CMS-10336.Supporting Statement Part A.docx Supporting Statement A Uploaded 2013-09-10 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
208653 495.342 - Frequency of Health Information Technology (HIT) Implementation Advanced Planning Document (IAPD) Updates New
208652 495.210 - Total cost of attestation for Stage 2 (MA-affiliated hospitals) New
208651 495.210 - Attesting on behalf of MA-affiliated hospitals New
208650 495.210 - Gather information for attestation (MA-affiliated hospitals) New
208649 495.210 - Total Cost of Attestation for Stage 2 (MA EPs) New
208648 495.210 - Attesting on behalf of MA EPs New
208647 495.210 - Gather information for attestation (MA EPs) New
208646 495.8 - CQMs for hospitals/CAHS New
208645 495.6 - Menu Set Objectives/Measures (Hospitals/CAHs) New
208644 495.6 - EHR Technology Used, Core Set Objectives/Measures (Hospitals/CAHS) New
208643 495.8 - CQMs for hospitals/CAHs New
208642 495.6 - Menu Set Objectives/Measures (EPs) average New
208641 495.6 EHR Technology Used, Core Set Objectives/Measures (EPs) New
195516 42 CFR 495.366 -- average Modified
195515 42 CFR 495.352 -- average Modified
195514 42 CFR 495.350--average Modified
195513 42 CFR 495.348(f) Modified
195512 42 CFR 495.348(e) Modified
195511 42 CFR 495.348(c) Modified
195510 42 CFR 495.330(a) - average Modified
195509 42 CFR 495.316 Modified
195508 42 CFR 495.306(a)(2) Modified
195507 42 CFR 495.306(a)(1)(ii)(B) Modified
195506 42 CFR 495.306(a)(1)(ii)(A) Modified
195505 42 CFR 495.306(a)(1)(i) Modified
195504 42 CFR 495.210(b) (2012) EPs-attestation Modified
195503 42 CFR 495.204(b)(5) or (b)(6)(2012) EPs-salary Modified
195502 42 CFR 495.204(b)(4) (2012) EPs-method Modified
195501 42 CFR 495.204(b)(2) (2012) Revenue reporting Modified
195500 42 CFR 495.202(b)(2) (2012) MA-affiliated hospitals-final ID Modified
195499 42 CFR 495.202(b)(2) (2012) EPs-final ID Modified
195498 42 CFR 495.202(b)(2) (2012) MA-affiliated hospitals-preliminary ID Modified
195497 42 CFR 495.202(b)(2) (2012) EPs-preliminary ID Modified
195496 42 CFR 495.10(d) - (hospital) (2012) Modified
195495 42 CFR 495.10(a) (b) (hospital) (2011) Modified
195494 42 CFR 495.10(e)(2) - (EPs) (2012) average Modified
195493 42 CFR 495.10(e)(1) - (EPs) (2011) average Modified
195492 42 CFR 495.10(d) - (EPs) (2012) average Modified
195491 42 CFR 495.10(a)-(c) -- (EPs) (2011) average Modified
195490 42 CFR 495.8 (b)(2)- Hospital Quality Measures (hospitals/CAHs) (2012) Modified
195489 42 CFR 495.8 (b)(2)- Menu Set Objectives/ Measures average (hospitals/CAHs) (2012) Modified
195488 42 CFR 495.8 (b)(2)-- EHR Technology Used & Core Set Objectives/Measures (hospitals/CAHs) (2012) Modified
195487 42 CFR 495.8(b)(1) - Menu Set Objectives/ Measures average (hospitals/CAHs) (2011) Modified
195486 42 CFR 495.8 (b)(1)-- EHR Technology Used, Core Set Objectives/Measures & Quality Measures (hospitals/CAHs) (2011) Modified
195485 42 CFR 495.8 (a)(2)- Ambulatory Quality Measures (EPs) (2012) Modified
195484 42 CFR 495.8 (a)(2)- Menu Set Objectives/ Measures average (EPs) (2012) Modified
195483 42 CFR 495.8(a)(2) - EHR Technology Used & Core Set Objectives/Measures (EPs) (2012) Modified
195482 42 CFR 495.8 (a)(1)- Menu Set Objectives/Measures average (EPs) (2011) Modified
195481 42 CFR 495.8 (a)(1)- EHR Technology Used, Core Set Objectives/Measures & Quality Measures (EPs) (2011) Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
04/30/2015 6 Months From Approved
4,495,264 0 0
4,792,112 0 0
0 0 0





Reginfo record details
49
table that charts list of burden
IC Title Form No. Form Name
42 CFR 495.204(b)(2) (2012) Revenue reporting
42 CFR 495.204(b)(4) (2012) EPs-method
42 CFR 495.204(b)(5) or (b)(6)(2012) EPs-salary
42 CFR 495.210(b) (2012) EPs-attestation
42 CFR 495.306(a)(1)(i)
42 CFR 495.306(a)(1)(ii)(A)
42 CFR 495.306(a)(1)(ii)(B)
42 CFR 495.306(a)(2)
42 CFR 495.316
42 CFR 495.330(a) - average
42 CFR 495.348(c)
42 CFR 495.348(e)
42 CFR 495.348(f)
42 CFR 495.350--average
42 CFR 495.352 -- average
42 CFR 495.366 -- average
495.6 EHR Technology Used, Core Set Objectives/Measures (EPs)
495.6 - Menu Set Objectives/Measures (EPs) average
495.8 - CQMs for hospitals/CAHs
495.6 - EHR Technology Used, Core Set Objectives/Measures (Hospitals/CAHS)
495.6 - Menu Set Objectives/Measures (Hospitals/CAHs)
495.8 - CQMs for hospitals/CAHS
495.210 - Gather information for attestation (MA EPs)
42 CFR 495.8 (a)(1)- EHR Technology Used, Core Set Objectives/Measures & Quality Measures (EPs) (2011)
42 CFR 495.8 (a)(1)- Menu Set Objectives/Measures average (EPs) (2011)
42 CFR 495.8(a)(2) - EHR Technology Used & Core Set Objectives/Measures (EPs) (2012)
42 CFR 495.8 (a)(2)- Menu Set Objectives/ Measures average (EPs) (2012)
42 CFR 495.8 (a)(2)- Ambulatory Quality Measures (EPs) (2012)
42 CFR 495.8 (b)(1)-- EHR Technology Used, Core Set Objectives/Measures & Quality Measures (hospitals/CAHs) (2011)
42 CFR 495.8(b)(1) - Menu Set Objectives/ Measures average (hospitals/CAHs) (2011)
42 CFR 495.8 (b)(2)-- EHR Technology Used & Core Set Objectives/Measures (hospitals/CAHs) (2012)
42 CFR 495.8 (b)(2)- Menu Set Objectives/ Measures average (hospitals/CAHs) (2012)
42 CFR 495.8 (b)(2)- Hospital Quality Measures (hospitals/CAHs) (2012)
42 CFR 495.10(a)-(c) -- (EPs) (2011) average
42 CFR 495.10(d) - (EPs) (2012) average
42 CFR 495.10(e)(1) - (EPs) (2011) average
42 CFR 495.10(e)(2) - (EPs) (2012) average
42 CFR 495.10(a) (b) (hospital) (2011)
42 CFR 495.10(d) - (hospital) (2012)
42 CFR 495.202(b)(2) (2012) EPs-preliminary ID
42 CFR 495.202(b)(2) (2012) MA-affiliated hospitals-preliminary ID
42 CFR 495.202(b)(2) (2012) EPs-final ID
42 CFR 495.202(b)(2) (2012) MA-affiliated hospitals-final ID
495.210 - Attesting on behalf of MA EPs
495.210 - Total Cost of Attestation for Stage 2 (MA EPs)
495.210 - Gather information for attestation (MA-affiliated hospitals)
495.210 - Attesting on behalf of MA-affiliated hospitals
495.210 - Total cost of attestation for Stage 2 (MA-affiliated hospitals)
495.342 - Frequency of Health Information Technology (HIT) Implementation Advanced Planning Document (IAPD) Updates

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 4,495,264 0 643,970 0 0 3,851,294
Annual Time Burden (Hours) 4,792,112 0 682,665 0 0 4,109,447
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No