Electronic Records Express

Forms and Documents

Document Name	Status
0960-0753 supporting statement (2009).doc Supporting Statement A	2009-06-11
0960-0753 addendum (2009).doc Supplementary Document	2009-06-09

IC Document Collections

IC ID	Document Title	Status
189280	Functionality for Electronic Medical Provide Reimbursement Requests Other-Elctronic Payment Request Screens	New
180253	ERE Registration Other-Users only need brief excerpts from this user guide	Modified

ICR Details

OMB Control No: 0960-0753	ICR Reference No: 200905-0960-015
Status: Historical Active	Previous ICR Reference No: 200705-0960-013
Agency/Subagency: SSA	Agency Tracking No:
Title: Electronic Records Express
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: 09/23/2009
	Date Received in OIRA: 06/12/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2012	36 Months From Approved	09/30/2010
Responses	17,689	0	20,000
Time Burden (Hours)	2,949	0	1,667
Cost Burden (Dollars)	0	0	0

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Abstract: Electronic Records Express (ERE) is a web-based SSA program medical providers and others use to electronically submit disability claim data to SSA. This ICR includes 1) the registration process for ERE and 2) a new functionality that allows medical providers to electronically submit reimbursement requests to SSA. The respondents are new ERE users and medical providers who are current ERE users.

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Authorizing Statute(s): PL: Pub.L. 105 - 277 - Name of Law: Government Paperwork Elimination Act
  

Citations for New Statutory Requirements: PL: Pub.L. 105 - 277 - Name of Law: Government Paperwork Elimination Act

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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:
	74 FR 15808	04/07/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 27379	06/09/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
ERE Registration
Functionality for Electronic Medical Provide Reimbursement Requests

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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	17,689	20,000	0	13,000	-15,311	0
Annual Time Burden (Hours)	2,949	1,667	0	2,168	-886	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: We added a new IC (programmatic change), which ROCIS registers as an increase. We also increased the response time based on updated data indicating our original estimate was too low. There was a decrease in the overall number of responses, but the overall change in burden is an increase.

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Annual Cost to Federal Government: $2,185,872

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

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: 06/12/2009

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