ML23254A227

OMB 3150-XXXX, New Draft Supporting Statement - NRC Form 995, Authorization for Use or Disclosure of Protected Health Information

ML23254A227
Person / Time
Issue date:	06/11/2024
From:	Center J Office of the Chief Human Capital Officer
To:
References
Download: ML23254A227 (4)

Text

DRAFT SUPPORTING STATEMENT FOR NRC FORM 995, AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION (3150-XXXX)

NEW Description of the Information Collection This clearance is being requested to collect information from an employee to authorize the agencys medical reviewing authority to contact their private health care provider. This authorization will be requested to determine and clarify disability status in the following situations: (1) An employee has requested reasonable accommodation and provided medical documentation; but further clarification or detail is needed to reach an appropriate determination on the request for accommodation; (2) an employee is requesting extended health care coverage for a disabled adult dependent beyond the age otherwise covered; or (3) an employee is requesting leave through the agency leave bank and/or the Family Medical Leave Act (FMLA), and there is a need to confirm information with the employees medical provider.

A. JUSTIFICATION

1. Need For the Collection of Information The legal authorities that justify the collection if this information are as follows:

Section 501 of the Rehabilitation Act of 1973, as amended Equal Employment Opportunity Commission (EEOC) Section 501 Final Rule 2018 29 CFR 1630: Regulations to implement the Equal Employment Provisions of the Americans with Disabilities Act Americans with Disabilities Act of 1990 (ADA), and Amendments Act 2008 (ADAAA) 5 USC Ch. 89: Health Insurance OPM Federal Employee Health Benefits (FEHB) Handbook The collection of this information, when needed, ensures that the agency provides effective reasonable accommodation and appropriate health care coverage.

2. Agency Use and Practical Utility of Information This information will be used to authorize contact between an employees private health care provider and the agencys medical reviewing authority. The information

2 collected ensures that this contact is sufficiently circumscribed to clarification of the issue under review and protects an employees personal health information.

3. Reduction of Burden Through Information Technology There are no legal obstacles to reducing the burden associated with this information collection. The NRC encourages respondents to use information technology when it would be beneficial to them.

The NRC has issued Guidance for Electronic Submissions to the NRC which provides direction for the electronic transmission and submittal of documents to the NRC. Electronic transmission and submittal of documents can be accomplished via the following avenues: the Electronic Information Exchange (EIE) process, which is available from the NRC's Electronic Submittals Web page, by Optical Storage Media (OSM) (e.g. CD-ROM, DVD), by facsimile or by e-mail. It is estimated that approximately 100% of the potential responses are filed electronically.

4. Effort to Identify Duplication and Use Similar Information No sources of similar information are available. There is no duplication of requirements.

5. Effort to Reduce Small Business Burden No small businesses are impacted by this clearance.

6. Consequences to Federal Program or Policy Activities if the Collection Is Not Conducted or Is Conducted Less Frequently If this information is not collected, the NRC will have no means to obtain necessary clarification regarding disabling medical conditions to reach a determination on a request for reasonable accommodation or a request for extended health care coverage to a disabled adult dependent. Absent this information, ineffective accommodations or unnecessary denials could occur.

There is no standard frequency for requesting this authorization. Information is collected as needed when information is received from employees and applicants.

Requests for this authorization may range from 10-30 times per year.

7. Circumstances Which Justify Variation from OMB Guidelines Not applicable.

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8. Consultations Outside the NRC Opportunity for public comment on the information collection requirements for this clearance package has been published in the Federal Register.

9. Payment or Gift to Respondents Not applicable.

10. Confidentiality of Information Confidential and proprietary information is protected in accordance with NRC regulations at 10 CFR 9.17(a) and 10 CFR 2.390(b). All medical information will be considered confidential.

The information submitted on Form 995 is maintained in three Privacy Act system of records designated as:

- NRC-21 (Payroll Accounting Records), described in the Federal Register (87 FR 64274; October 24, 2022)

- NRC-43 (Employee Health Center Records), described in the Federal Register (84 FR 71572; December 27, 2019)

- NRC-11 (Reasonable Accommodation Records), described in the Federal Register (87 FR 64266; October 24, 2022)

Privacy Act statements are included on the NRC Form 995.

11. Justification for Sensitive Questions The NRC considers the collection this information necessary to determining the agencys legal obligation to provide an accommodation or extend health care coverage. This information is considered sensitive. The Reasonable Accommodation Coordinator will be responsible for contacting the requestor by phone or email to explain the need for documentation.

12. Estimated Burden and Burden Hour Cost The estimate is assuming the higher estimate of 30 requests for authorization per year.

4 Section/Form Description Number of Respondents Number of Responses Per Respondent Total Annual Responses Burden Hrs Per

Response

Total Annual Burden (Hrs)

Cost @

$300/Hr NRC 995 Authorization for Disclosure of Medical Information 30 1

30 1.25 37.50

$11,250 The $300 hourly rate used in the burden estimates is based on the Nuclear Regulatory Commissions fee for hourly rates as noted in 10 CFR 170.20 Average cost per professional staff-hour. For more information on the basis of this rate, see the Revision of Fee Schedules, Fee Recovery for Fiscal Year 2023 (88 FR 39120, June 15, 2023).

13. Estimate of Other Additional Costs No other additional costs are anticipated.

14. Estimated Annualized Cost to the Federal Government The staff has developed estimates of annualized costs to the Federal Government related to the conduct of this collection of information. These estimates are based on staff experience and subject matter expertise and include the burden needed to review, analyze, and process the collected information and any relevant operational expenses.

NRC staff expends approximately 4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> reviewing, processing, and analyzing each matter requiring this authorization. Situations that are more complex or extensive could need more time. Based upon an estimate of 30 per year, an annual total of 120 hours0.00139 days <br />0.0333 hours <br />1.984127e-4 weeks <br />4.566e-5 months <br /> is expended on these activities. The annual cost to the Federal government is approximately $36,000 (120 hrs. x $300).

15. Reasons for Change in Burden or Cost This is a new OMB Clearance.

16. Publication for Statistical Use Not applicable.

17. Reason for Not Displaying the Expiration Date The expiration date will be displayed.

18. Exceptions to the Certification Statement The collection of information does not employ statistical methods.