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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-0357
ICR Reference No:
200208-0938-006
Status:
Historical Active
Previous ICR Reference No:
200104-0938-004
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Home Health Services Under Hospital Insurance, Manual Instructions and Supporting Regulations in 42 CFR 409.40 - 50, 410.36, 410.170, 411.4-.15, 421.100, 424.22, 484.18 and 489.21
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
11/20/2002
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/15/2002
Terms of Clearance:
This information collection request is approved with the revised supporting statement and supplemental information provided by CMS on 11/06/2002. OMB notes that the form 485 is a voluntary means by which providers may demonstrate their compliance with the home health plan of care regulatory requirements. CMS is encouraged to continue to evaluate this collection in the context of OASIS and to look for ways of streamlining administrative burden. CMS must also continue its work on developing electronic signature capability for this and other automated collections. OMB notes that this collection contains revised burden estimates that now incorporate its burden on physicians. OMB commends CMS for making this correction and reminds the agency to consider the burden on all of a collection's respondents when doing such calculations in the future.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2005
11/30/2005
11/30/2002
Responses
4,750,000
0
5,580,000
Time Burden (Hours)
1,583,333
0
1,395,000
Cost Burden (Dollars)
0
0
0
Abstract:
This information is used by the Regional Home Health Intermediaries to ensure reimbursement is made to home health agencies only for services that are covered and medically necessary under Part A and Part B. The attending physician must sing the form 485 or the plan of care authorizing the home health services for a period not to exceed 60 days.
Authorizing Statute(s):
None
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Home Health Services Under Hospital Insurance, Manual Instructions and Supporting Regulations in 42 CFR 409.40 - 50, 410.36, 410.170, 411.4-.15, 421.100, 424.22, 484.18 and 489.21
CMS-485
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
4,750,000
5,580,000
0
0
-830,000
0
Annual Time Burden (Hours)
1,583,333
1,395,000
0
0
188,333
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:
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]?
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:
08/15/2002
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