Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System (CMS-10175)

ICR 201705-0938-009

OMB: 0938-0984

Federal Form Document

ICR Details
0938-0984 201705-0938-009
Historical Active 201309-0938-010
HHS/CMS 20493
Certification Statement for Electronic File Interchange Organizations that Submit NPI Data to the National Plan and Provider Enumeration System (CMS-10175)
Reinstatement with change of a previously approved collection   No
Approved with change 12/11/2017
Retrieve Notice of Action (NOA) 05/24/2017
  Inventory as of this Action Requested Previously Approved
12/31/2020 36 Months From Approved
21 0 0
5 0 0
0 0 0

Health care providers can currently obtain a National Provider Identifier (NPI) via a paper application or over the Internet through the National Plan and Provider Enumeration System (NPPES). These applications must be submitted individually, on a per-provider basis. The Electronic File Interchange (EFI) process allows provider-designated organizations (EFIOs) to capture multiple providers' NPI application information on a single electronic file for submission to NPPES. (This process is also referred to as "bulk enumeration.") To ensure that the EFIO has the authority to act on behalf of each provider and complies with other Federal requirements, an authorized official of the EFIO must sign a certification statement and mail it to the Centers for Medicare and Medicaid Services (CMS).

PL: Pub.L. 104 - 191 Title II Name of Law: Health Insurance Portability and Accountability Act

Not associated with rulemaking

  82 FR 11921 02/27/2017
82 FR 23005 05/19/2017

  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 21 0 0 0 -4 25
Annual Time Burden (Hours) 5 0 0 0 -70 75
Annual Cost Burden (Dollars) 0 0 0 0 0 0
The burden has decreased for two reasons. The first is we are using more accurate data from NPPES to estimate respondents who use the Certification Statement for Electronic File Interchange Organizations (EFIOs). By doing so, we have decreased the first part of our estimate by 4, from 25 respondents to 21 respondents. The second is the previous estimate assumed that it would take respondents 3 hours to complete and submit their certification statements. This has been proven to be an incorrect assumption. NPPES currently reports that the CMS-10175 is usually completed, signed and submitted by a professional, such as a chief member of the organization acting as the Authorized Representative for the organization. The CMS-10175 form is comprised of 3 pages, only one of which has minimal data fields to be completed and a certification statement to be signed. NPPES now estimates that completion of those data fields and their submission takes 15 minutes to complete. The previous burden hour estimate was 75 hours. That decreases the burden hour estimate by 69.75 hours (from 75 to 5.25 hours). Combined, the annual decrease in burden hours is 69.75 (from 75 to 5.25 hours) and the The decrease in the number of respondents is 4 (from 25 to 21).

Jamaa Hill 301 492-4190


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:
    (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;
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.

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