SSA Health IT Partner Assessment - Participating Facilities and Available Content Form, SSA-680

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-680 Health IT Partner Assessment	Form	Modified	Available
Form SSA-680 Health IT Partner Assessment - SSA-680	Form	Modified	Repair queued
Supporting Statement - 0798.docx	Supporting Statement A	Uploaded 2025-04-17	Repair queued
Supporting Statement - 0798.docx	Supporting Statement A	Uploaded 2025-04-17	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
201618	Health IT Partner Assessment - SSA-680	Form	Modified	Health IT Partner Assessment
201618	Health IT Partner Assessment - SSA-680	Form	Modified

ICR Details

OMB Control No: 0960-0798	ICR Reference No: 202501-0960-006
Status: Active	Previous ICR Reference No: 202109-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: SSA Health IT Partner Assessment - Participating Facilities and Available Content Form, SSA-680
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/19/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/17/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2028	36 Months From Approved	05/31/2025
Responses	10	0	30
Time Burden (Hours)	402	0	1,200
Cost Burden (Dollars)	0	0	0

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Abstract: The Health Information Technology for Economic and Clinical Health (HITECH) Act promotes the adoption and meaningful use of health information technology (IT), particularly in the context of working with government agencies. Similarly, section 3004 of the Public Health Service Act requires health care providers or health insurance issuers with government contracts to implement, acquire, or upgrade their health IT systems and products to meet adopted standards and implementation specifications. To support expansion of SSA's health IT initiative as defined under HITECH, SSA developed Form SSA-680, the Health IT Partner Program Assessment – Participating Facilities and Available Content Form. The SSA 680 allows healthcare providers to provide the information SSA needs to determine their ability to exchange health information with us electronically. We evaluate potential partners (i.e., healthcare providers and organizations) on (1) the accessibility of health information they possess, and (2) the content value of their electronic health records' systems for our disability adjudication processes. SSA reviews the completeness of organizations' SSA-680 responses as one part of our careful analysis of their readiness to enter into a health IT partnership with us. The respondents are healthcare entities, healthcare providers, and HIEs who wish to engage in a Health IT partnership with SSA.

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Authorizing Statute(s): US Code: 42 USC 17902 Name of Law: HITECH Act
  

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:
	90 FR 9488	02/12/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 16050	04/16/2025
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
Health IT Partner Assessment - SSA-680	SSA-680	Health IT Partner Assessment

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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	10	30	0	0	-20	0
Annual Time Burden (Hours)	402	1,200	0	0	-798	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: When we last cleared this IC in 2022, the burden was 1,200 hours. However, we are currently reporting a burden of 400 hours. This change is due to the fact that SSA is focusing our outreach on partners who do not need to complete the SSA 680 (Epic EMR customers who already possess the necessary requirements to partner with SSA under HIT). While we still welcome non-Epic customers, which require the use of the SSA-680, we are seeing fewer of them applying annually to be partners with us. There are no changes to the public reporting burden. * Note: The total burden reflected in ROCIS is 402, while the burden cited in #12 of the Supporting Statement is 400. This discrepancy is because the ROCIS burden reflects the learning costs in addition to the normal burden costs for the form. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

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Annual Cost to Federal Government: $10,750

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

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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: 04/17/2025

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