Survey of Medical Care Providers for the Evaluation of the Regional Extension Center (REC) Program

Forms and Documents

Document Name	Status
20475 ID_Supporting Statement Part B 120513.doc Supporting Statement B	2013-12-18
20745 ID_ REC Supporting Statement A 120513.doc Supporting Statement A	2013-12-18

IC Document Collections

IC ID	Document Title	Status
209872	Practice Managers Form C Shortened Survey Administered on Paper Other-survey	New
209871	Nurses Form C Shortened Survey Administered on Paper Other-survey	New
209870	Physicians Form C Shortened Survey Administered on Paper Other-survey	New
209869	Practice Managers Form B Survey Administered as a Computer-Assisted Telephone Interview Other-Survey	New
209868	Nurses Form B Survey Administered as a Computer-Assisted Telephone Interview Other-Survey	New
209867	Physicians Form B Survey Administered as a Computer Assisted Telephone Interview Other-Survey	New
209866	Practice Managers Form A Screener Administered on Paper Other-screener	New
209865	Nurses Form A Screener Administered on Paper Other-screener	New
209864	Physicians Form A Screener Administered on Paper Other-survey	New

ICR Details

OMB Control No: 0955-0015	ICR Reference No: 201312-0955-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ONC	Agency Tracking No: 20475
Title: Survey of Medical Care Providers for the Evaluation of the Regional Extension Center (REC) Program
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: 03/12/2014
	Date Received in OIRA: 12/23/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved
Responses	6,494	0	0
Time Burden (Hours)	1,167	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The survey data will be analyzed to determine whether there is an association between REC participation and the use of technical assistance, EHR adoption, and achievement of meaningful use of electronic health records by primary care practices. The data will also be used to identify challenges faced by primary care practices when adopting and meaningfully using EHRs

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 57638	09/19/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	30 FR 77465	12/23/2013
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 9

IC Title	Form No.	Form Name
Physicians Form A Screener Administered on Paper
Nurses Form A Screener Administered on Paper
Practice Managers Form A Screener Administered on Paper
Physicians Form B Survey Administered as a Computer Assisted Telephone Interview
Nurses Form B Survey Administered as a Computer-Assisted Telephone Interview
Practice Managers Form B Survey Administered as a Computer-Assisted Telephone Interview
Physicians Form C Shortened Survey Administered on Paper
Nurses Form C Shortened Survey Administered on Paper
Practice Managers Form C Shortened Survey Administered on Paper

---

ICR Summary 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	6,494	0	0	6,494	0	0
Annual Time Burden (Hours)	1,167	0	0	1,167	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: New collection

---

Annual Cost to Federal Government: $330,000

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

---

Common Form ICR:  No

---

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: 12/23/2013

---