Electronic Records Express

Forms and Documents

Document Name	Status
Addendum - 0753.doc Supplementary Document	2014-09-23
Supporting Statement - 0753.doc Supporting Statement A	2014-09-23

IC Document Collections

IC ID	Document Title	Status
180253	ERE Other-Sreen Shots	Modified

ICR Details

OMB Control No: 0960-0753	ICR Reference No: 201405-0960-004
Status: Historical Active	Previous ICR Reference No: 201202-0960-003
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: 10/24/2014
	Date Received in OIRA: 09/24/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	36 Months From Approved	08/31/2015
Responses	4,508,968	0	3,552,176
Time Burden (Hours)	751,495	0	592,029
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:
	79 FR 35628	07/23/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 56428	09/19/2014
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
ERE

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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	4,508,968	3,552,176	0	0	956,792	0
Annual Time Burden (Hours)	751,495	592,029	0	0	159,466	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: The increase in the burden hours is due to an increase in the number of yearly responses for ERE. We anticipate further increases as more respondents choose to submit evidence and request payment electronically through ERE.

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Annual Cost to Federal Government: $0

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: 09/24/2014

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