Assessment of Unreimbursed Care among Community Primary Care Physicians

Forms and Documents

Document Name	Status
Supporting Statement 11-21-06 v3.doc Supporting Statement B	2006-11-21
Attachment 4 11-21-06.doc Supplementary Document	2006-11-21
Attachment 3 11-21-06.doc Supplementary Document	2006-11-21
Attachment 2 11-21-06.doc Supplementary Document	2006-11-21
Supporting Statement 11-21-06 v3.doc Supporting Statement A	2006-11-21

IC Document Collections

IC ID	Document Title	Status
46414	Assessment of Unreimbursed Care among Community Primary Care Physicians Other-Other	New

ICR Details

OMB Control No: 0935-0129	ICR Reference No: 200612-0935-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Assessment of Unreimbursed Care among Community Primary Care Physicians
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 with change	Conclusion Date: 03/28/2007
	Date Received in OIRA: 12/13/2006
Terms of Clearance: This ICR is approved, in its revised form, on the understanding that AHRQ will notify OMB if the IRB has suggested any modifications to the instruments or the study design, prior to fielding the survey.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2010	36 Months From Approved
Responses	780	0	0
Time Burden (Hours)	195	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This project is being conducted as part of AHRQ's Primary Care Practice-Based Research Networks (PBRN). One of AHRQ's PBRN contractors, the American Academy of Family Physician's National Research Network (AAFP-NRN), will survey primary care practices participating in its PBRN in order to assess the current state of un- reimbursed medical care provided in community based primary care practices. There has been substantial research conducted to quantify the amount of un-reimbursed care provided in private physicians' offices. This survey will collect information from a sample of community-based primary care practices that are widely representative of private physicians across the United States in order to understand the current state of private primary care office un-reimbursed care and help assess factors that encourage and discourage practices from engaging in this activity. The AAFP-NRN will collaborate with AHRQ on the design of a self- administered, web-based questionnaire. The survey will collect information pertaining to the level of un-reimbursed care in the practice as well as characteristics of the practice, the physician(s)and the patient population.

---

Authorizing Statute(s): US Code: 9 USC 580 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 43773	08/02/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 59791	10/11/2006
Did the Agency receive public comments on this ICR? Yes

---

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

IC Title	Form No.	Form Name
Assessment of Unreimbursed Care among Community Primary Care Physicians

---

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	780	0	0	780	0	0
Annual Time Burden (Hours)	195	0	0	195	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 is a new collection.

---

Annual Cost to Federal Government: $129,956

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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: 11/30/2006

---