Electronic Health Record Incentive Program-Stage 3 (CMS-10552)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10552_Supporting_Statement_Part_A - Final (12-21-16).docx	Supporting Statement A	Uploaded 2016-12-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
216085	?495.316 – Quarterly Reporting		Modified
216084	?495.210 –Attestation on behalf of MA EPs		Modified
216083	?495.210 - Gather information for attestation (MA EPs)		Modified
216082	?495.24 Objectives/Measures (hospitals/CAHs)		Modified
216075	? 495.24-Objectives/Measures (EPs)		Modified

ICR Details

OMB Control No: 0938-1278	ICR Reference No: 201510-0938-005
Status: Historical Active	Previous ICR Reference No: 201504-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Electronic Health Record Incentive Program-Stage 3 (CMS-10552)
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 with change	Conclusion Date: 12/23/2016
	Date Received in OIRA: 10/30/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	36 Months From Approved
Responses	641,494	0	0
Time Burden (Hours)	4,230,155	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Medicare and Medicaid Services is requesting approval to collect information from eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs) in order to implement requirements under Stage 3 of the Medicare and Medicaid EHR Incentive Programs.

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Authorizing Statute(s): PL: Pub.L. 111 - 5 Title IV of Division B Name of Law: The American Recovery and Reinvestment Act of 2009
   PL: Pub.L. 111 - 5 Title XIII of Division A Name of Law: The American Recovery and Reinvestment Act of 2009
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 5 Title IV of Division B Name of Law: The American Recovery and Reinvestment Act of 2009
PL: Pub.L. 111 - 5 Title XIII of Division A Name of Law: The American Recovery and Reinvestment Act of 2009

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS26	Final or interim final rulemaking	80 FR 62762	10/16/2015

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
§495.24 Objectives/Measures (hospitals/CAHs)
§495.210 - Gather information for attestation (MA EPs)
§495.316 – Quarterly Reporting
§495.210 –Attestation on behalf of MA EPs
§ 495.24-Objectives/Measures (EPs)

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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	641,494	0	641,494	0	0	0
Annual Time Burden (Hours)	4,230,155	0	4,230,155	0	0	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: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

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Annual Cost to Federal Government: $10,000,000

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)? Yes

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: 10/30/2015

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