SS Part A - HCUP Online Order Form - 9 5 2025 finalv2

SUPPORTING STATEMENT

Part A

Online Application Order Form for Products from the Healthcare Cost and Utilization Project (HCUP)

Revision of Previously Approved Information Collection – 0935-0206

Version: 9/5/2025

Agency for Healthcare Research and Quality (AHRQ)

Table of contents

A. Justification 3

1. Circumstances that make the collection of information necessary 3

2. Purpose and use of information 5

3. Use of Improved Information Technology 5

4. Efforts to Identify Duplication 5

5. Involvement of Small Entities 5

6. Consequences if Information Collected Less Frequently 5

7. Special Circumstances 5

8. Consultation outside the Agency 6

9. Payments/Gifts to Respondents 6

10. Assurance of Confidentiality 6

11. Questions of a Sensitive Nature 7

12. Estimates of Annualized Burden Hours and Costs 7

13. Estimates of Annualized Respondent Capital and Maintenance Costs 8

14. Estimates of Annualized Cost to the Government 8

15. Changes in Hour Burden 9

16. Time Schedule, Publication and Analysis Plans 9

17. Exemption for Display of Expiration Date 9

List of Attachments 9

A. Justification

1. Circumstances that make the collection of information necessary

About AHRQ:

The mission of the Agency for Healthcare Research and Quality (AHRQ) set out in its authorizing legislation, The Healthcare Research and Quality Act of 1999 (see https://www.ahrq.gov/policymakers/hrqa99a.html), is to enhance the quality, appropriateness, and effectiveness of health services, and access to such services, through the establishment of a broad base of scientific research and through the promotion of improvements in clinical and health systems practices, including the prevention of diseases and other health conditions. AHRQ shall promote health care quality improvement by conducting and supporting:

1. Research that develops and presents scientific evidence regarding all aspects of health care; and

2. The synthesis and dissemination of available scientific evidence for use by patients, consumers, practitioners, providers, purchasers, policy makers, and educators; and

3. Initiatives to advance private and public efforts to improve health care quality.

Also, AHRQ shall conduct and support research and evaluations, and support demonstration projects, with respect to (A) the delivery of health care in inner-city areas, and in rural areas; and (B) health care for priority populations, which shall include (1) low-income groups, (2) minority groups, (3) women, (4) children, (5) the elderly, and (6) individuals with special health care needs, including individuals with disabilities and individuals who need chronic care or end-of-life health care.

Summary of this Information Collection Request (ICR):

This ICR is for a revision to 0935-0206, “Online Application Order Form for Products from the Healthcare Cost and Utilization Project.” Revisions include a redesigned HCUP application form and reducing the number of DUAs to one state and one nationwide version. The current expiration date for 0935-0206 was 5/31/2025 and AHRQ is requesting a new expiration date, 3 years from approval of this ICR.

Background of the Healthcare Cost and Utilization Project (HCUP):

The Healthcare Cost and Utilization Project is a vital resource helping the Agency achieve its research agenda, thereby furthering its goal of improving the delivery of health care in the United States. HCUP is a family of health care databases developed through a Federal-State-Industry partnership and sponsored by AHRQ. HCUP includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information beginning in 1988. The HCUP databases are annual files that contain anonymous information from hospital discharge records for inpatient care and certain components of outpatient care, such as emergency care and ambulatory surgeries.

The project currently creates eight types of restricted access public release databases and related files that are released to authorized users under the terms of the HCUP Data Use Agreement (DUA). These HCUP databases and files are used by researchers for a broad range of health issues, including cost and quality of health services, medical practice patterns, access to health care programs, and outcomes of treatments at the national, State, and local market levels.

The goal of the Online Application Order Form for Products from the Healthcare Cost and Utilization Project is to:

• Allow restricted access public release and tracking of the eight HCUP databases.

To achieve this goal the following data collections and activities are required:

1. HCUP DUA Training Course - All purchasers and users of HCUP data must complete this training prior to signing the DUA. This Web-based training course outlines important terms of the DUA. The purpose of the course is to emphasize the importance of data protection, reduce the risk of inadvertent violations, and describe an individual’s responsibility when using HCUP data. After completing the training course, an HCUP DUA Training Course certification code is received. This code is required to purchase or gain access to HCUP data. See Attachment A.

2. HCUP DUA for the Nationwide Databases - The HCUP Nationwide databases include the National (Nationwide) Inpatient Sample (NIS), Kids’ Inpatient Database (KID), Nationwide Ambulatory Surgery Sample (NASS), Nationwide Emergency Department Sample (NEDS), and Nationwide Readmissions Database (NRD). Any person seeking permission from AHRQ to access HCUP Nationwide Databases must sign and submit this Agreement to AHRQ. See Attachment B.

3. HCUP DUA for the State Databases - The HCUP State databases include the State Inpatient Databases (SID), State Ambulatory Surgery and Services Databases (SASD), and State Emergency Department Databases (SEDD). Any person seeking permission from AHRQ to access HCUP State Databases must sign and submit this Agreement to AHRQ. See Attachment C.

4. Online Application Form – The application form collects relevant applicant information, shipping and billing address, and the payment method. See Attachment D.

The HCUP project and the Online Application Form for HCUP Products is being conducted by AHRQ through its contractor pursuant to AHRQ’s statutory authority to conduct and support research on healthcare and on systems for the delivery of such care, including activities with respect to the outcomes, cost, cost-effectiveness, and use of health care services and access to such services. 42 U.S.C. 299a(a)(3).

2. Purpose and Use of Information

Information collected in the HCUP Online Application Form process will be used for two purposes only:

1. Business Transaction: In order to deliver the HCUP databases to the applicants, contact information is necessary for shipping the data on disk (or any other media used in the future) and payment collection.

2. Enforcement of the HCUP Data Use Agreement (DUA): The HCUP DUA contains several restrictions on use of the data. Most of these restrictions have been put in place to safeguard the privacy of individuals and establishments represented in the data. For example, data users can only use the data for research, analysis, and aggregate statistical reporting and are prohibited from attempting to identify any persons in the data. Contact information on HCUP DUAs is retained in the event that a violation of the HCUP DUA takes place requiring legal remedy.

3. Use of Improved Information Technology

Online Application Form for HCUP Products uses a software-based data entry process to collect the required information and eliminate the need to print and mail a hard copy application form. The online HCUP database ordering process streamlines the ordering process for the public and facilitates accurate and cost-efficient record keeping for the Agency. To reduce burden, multiple products may be ordered in a single application. Further, existing account information is populated into the Online Application Form for HCUP Products, so response time for repeat users to complete any subsequent applications is reduced.

4. Efforts to Identify Duplication

No other source of data is available to allow AHRQ to deliver data to purchasers or allow follow up in the event of a HCUP DUA violation. This information collection does not duplicate any other effort, and the information cannot be obtained from any other source.

5. Involvement of Small Entities

The information being requested has been held to the absolute minimum required for the intended use.

6. Consequences if Information Collected Less Frequently

Information is collected with each submission of the Online Application Form for HCUP Products to ensure that purchased databases are delivered to the user’s current shipping address and that payment may be processed correctly. Without collection of information using the application ordering form, it would not be possible to conduct an electronic ordering process to facilitate public access to research data.

7. Special Circumstances

This request is consistent with the general information collection guidelines of 5 CFR 1320.5(d)(2). No special circumstances apply.

8. Federal Register Notice and Outside Consultations

8.a. Federal Register Notice

As required by 5 CFR 1320.8(d), the notice was published in the Federal Register on April 30, 2025, Volume 90, on page 17937 for 60 days (see Attachment E). No comments were received. There are changes in the total burden cost as per Exhibit 2 in the 60 Day FRN due to a transcription error, and a new requirement to base cost burden on adjusted hourly wages and updating wages to the most recent available estimates (from May 2024). These changes resulted in the cost burden to increase from $78,252 to $102,501. This change is reflected and explained in the 30 Day FRN.

8.b. Outside Consultations

AHRQ did not consult with any outside individual or agency with respect to this information collection. The information collection required as a part of the online application process is an absolute minimum for conducting the transaction and is modeled on a process already established by the National Technical Information Service (NTIS) at https://www.ntis.gov/about/about-us.xhtml. AHRQ is unable to utilize NTIS for dissemination of HCUP databases because of special circumstances required for release of the data; 1) the need to review applications for state-level data to ensure that the planned use is consistent with HCUP policies and with the HCUP data use requirements, and 2) the need to retain copies of signed HCUP DUAs.

9. Payments/Gifts to Respondents

No payment, gift or remuneration will be provided to respondents.

10. Assurance of Confidentiality

The confidentiality of information about individuals and organizations is protected under Section 934(c) of the Public Health Service Act, 42 USC 299c-3(c). The public is informed of the purposes for which the information is collected and that, in accordance with this statute, any identifiable information about them will not be used or disclosed for any other purpose.

Information that can directly identify respondents is collected. Information collected includes name, organization, street address, phone number, and e-mail address. All information collected is necessary for the commercial transaction including shipment of the data requested and for follow up in the event of a potential violation of the HCUP DUA.

The identifiable information collected is transmitted to the hosting server via an encrypted Secure Socket Layer (SSL) connection. Access to the database housing the identifiable information is accomplished through individual authorized administrative accounts. The server is hosted within the AHRQ AWS Enclave - a managed, cloud infrastructure General Shared Service (GSS). It utilizes Amazon’s Infrastructure as a Service (IaaS) solution to provide a secure and redundant infrastructure. AWS is a cloud-based architecture that provides a Monthly Uptime Percentage of at least 99.95%. AHRQ utilizes this GSS as a hosting environment for various systems and applications. The AHRQ AWS Enclave has and existing Authority to Operate (ATO) as a FISMA Moderate system.

The GSS utilizes Amazon AWS services to provide standardized OS/network/and security configurations for all Projects within the Enclave to utilize. All deployed Operating Systems (OS) are configured in accordance with the DISA STIGS. Any deviations from the standard DISA STIG are documented with a justification. The GSS also provides a secure environment and Information Assurance (IA) tools. All commercial tools and applications used within the Enclave must be FedRAMP certified.

The Enclave environments also sit behind Web Application Firewalls (WAF), Palo Alto Firewalls and utilize a Transit Gateway with a single ingress load balancer for publicly available websites. This decreases the avenues of attack on a system to a single endpoint, mitigating risk and vulnerabilities. Essentially, a virtual TIC environment.

The information collected by the electronic form are stored in a secure database. Data stored in the database will remain there indefinitely until requested by AHRQ. At the conclusion of the contract, the information system as well as a current copy of the database can be provided to AHRQ by request.

The information system uses a defense-in-depth strategy for user access. Users are assigned individual credentials along with role based least-privileged user account (LUA). The LUA approach ensures that users follow the principle of least privilege and always log on with limited user accounts. This strategy also aims to limit the use of administrative credentials to administrators, and then only for administrative tasks.

Public users of the information system establish their credentials upon entry to the system by using their e-mail address as the user ID and specifying their own password. That password is securely stored in the system’s database. The credentials are needed so that a public user can reference their order history. If a user forgets his/her password, the system will reset it and convey that information via e-mail. The public user will have to change that default password upon reentry to the system. Administrative users of the information system have credentials assigned to them by the system administrator. Various role levels are defined, each allowing the administrative user permissions to perform specific functions.

The information system allows applicants to specify a payment option of credit card, ACH or direct payment. Information to complete credit card and ACH transaction is collected by the information system and transmitted securely to a PCI-compliant payment gateway (FISMA-compliant Authorize.net) for approval. The payment gateway product processes the transaction and the funds are transferred when the transaction is captured at the time of the order is fulfilled and the data is shipped. Credit card information is not captured or retained by the information system’s database.

11. Questions of a Sensitive Nature

No questions of a sensitive nature will be asked.

12. Estimates of Annualized Burden Hours and Costs

Exhibit 1 shows the estimated annualized burden associated with the applicants’ time to order any of the HCUP databases. An estimated 1,800 persons will order HCUP data annually. To complete the ordering process, each of these persons will complete the HCUP DUA Training Course, review and sign both DUAs, and complete the HCUP Data Purchase Ordering Form. The total burden to complete these four steps to purchase HCUP data is estimated to be 1,050 hours annually.

Exhibit 2 shows the estimated annualized cost burden associated with the applicants’ time to purchase HCUP data. This The total cost burden is estimated to be $102,921 annually.

Exhibit 1.  Estimated annualized burden hours

Form Name	Number of respondents	Number of responses per respondent	Hours per response	Total burden hours
1. HCUP DUA Training Course	1,800	1	15/60	450
2. HCUP DUA for the Nationwide Databases	1,800	1	5/60	150
3. HCUP DUA for the State Databases	1,800	1	5/60	150
4. HCUP Data Purchase Ordering Form	1,800	1	10/60	300
Total	1800	NA	35/60	1,050

 

Exhibit 2. Estimated annualized cost burden

	Total burden hours	Average hourly wage rate*	Adjusted hourly wage rate**	Total cost burden
1. HCUP DUA Training Course	450	$49.01	$98.02	$44,109
2. HCUP DUA for the Nationwide Databases	150	$49.01	$98.02	$14,703
3. HCUP DUA for the State Databases	150	$49.01	$98.02	$14,703
4. HCUP Data Purchase Ordering Form	300	$49.01	$98.02	$29,406
Total	1,050	NA	NA	$102,921

*Based upon the mean of the average wages for Life Scientists, All Other (19-1099), National Compensation Survey:

Occupational Employment Statistics, May 2024 National Occupational Employment and Wage Estimates United States, U.S. Department of Labor, Bureau of Labor Statistics. https://data.bls.gov/oes/#/industry/000000

**The Adjusted Hourly Rate was estimated at 200% of the hourly wage.

13. Estimates of Annualized Respondent Capital and Maintenance Costs

There are no direct costs to respondents other than their time to submit the online application order form.

14. Estimates of Annualized Cost to the Government

Exhibit 3 shows the estimated total and annualized cost to process HCUP database applications and maintain the security of the ordering system over the 3 years covered by this information collection request. It is estimated to cost $33,648 annually to operate and maintain the ordering system.

Exhibit 3.  Estimated Total and Annualized Cost

Cost Component	Total Cost	Annualized Cost
Application Review	$26,700	$8,900
Maintenance/Troubleshooting	$27,444	$9,148
Customer Inquiries	$46,800	$15,600
Total	$101,154	$33,648

Exhibit 4. Federal Government Personnel Annual Cost

Activity		Federal Personnel	Hourly Rate*	Adjusted Hourly Rate**	Estimated Hours	Cost
Data Collection Oversight		1 (GS-13 Step 9)	$73.43	$146.86	440	$64,618
	Total					$64,618

* Based on annual salaries from the 2025 OPM Pay Schedule for Washington/DC area:

http://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2025/DCB.pdf

**The Adjusted Hourly Rate was estimated at 200% of the hourly wage.

15. Changes in Hour Burden

There have been no changes in public use of the system (i.e., the number of respondents), however there is an increase in the burden hours with this ICR, from 900 to 1,050 hours. This increase in burden is due to a more accurate accounting of the burden associated with the individual steps in the ordering process.

16. Time Schedule, Publication and Analysis Plans

The Online Application Form for HCUP Products and the related order tracking system was implemented in the fall of 2012 and is on-going.

17. Exemption for Display of Expiration Date

AHRQ does not seek this exemption.

List of Attachments:

Attachment A – HCUP DAU Training Course

Attachment B –DAU for the Nationwide Databases from HCUP

Attachment C –DAU for the State Databases from HCUP

Attachment D - Online Application Order Form

Attachment E - 60 Day Federal Register Notice

Attachment F- 30 Day Federal Register Notice