National Emergency Medical Services Information System (NEMSIS) – State Submission to National EMS Database

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Part A Supporting Statements - NEMSIS 11 Nov 2015_SM_FINAL.docx	Supporting Statement A	Uploaded 2016-01-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
219827	National Emergency Medical Services Information System (NEMSIS) – State Submission to National EMS Database		New

ICR Details

OMB Control No: 2127-0717	ICR Reference No: 201601-2127-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOT/NHTSA	Agency Tracking No:
Title: National Emergency Medical Services Information System (NEMSIS) – State Submission to National EMS Database
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: 08/17/2016
	Date Received in OIRA: 02/25/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved
Responses	56	0	0
Time Burden (Hours)	1,008	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: NHTSA is proposing to collect and aggregate limited information from state level reporting entities that can be used to describe the Emergency Medical Services (EMS) patient care provided across the United States, to measure improvements in the quality of care provided by EMS agencies and EMS systems, and to assist NHTSA in determining the impact EMS has on Highway Safety and post-crash care. One of the objectives of NEMSIS is to provide a standardized approach to documentation of EMS incident response and patient care at the local level, to provide a sub-set of that data to the State level, then the states submit an even smaller sub-set of the data to populate the National EMS Database

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Authorizing Statute(s): None

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:
	80 FR 34786	06/17/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 292	01/05/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
National Emergency Medical Services Information System (NEMSIS) – State Submission to National EMS Database

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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	56	0	0	56	0	0
Annual Time Burden (Hours)	1,008	0	0	1,008	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 new information collection results in a program change of adding the total estimated burden hours (1008 hours) for this information collection to NHTSA’s overall agency total.

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Annual Cost to Federal Government: $1,500,000

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)? 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: 02/25/2016

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