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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:
0938-0610
ICR Reference No:
200810-0938-019
Status:
Historical Active
Previous ICR Reference No:
200508-0938-001
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Advanced Directives (Medicare and Medicard) - BDP-718
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:
05/08/2009
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/31/2008
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2012
36 Months From Approved
05/31/2009
Responses
20,378,336
19,871,040
33,096
Time Burden (Hours)
1,178,927
927,550
924,120
Cost Burden (Dollars)
0
0
0
Abstract:
Certain Medicare and Medicaid organizations are responsible for collecting and documenting in a prominent place in medical records whether an individual has executed an advanced directive. This document indicates the individual's preference if he/she is incapacitated.
Authorizing Statute(s):
PL: Pub.L. 101 - 508 4751 Name of Law: Omnibus Reconciliation Act of 1990
PL: Pub.L. 101 - 508 4206 Name of Law: Omnibus Reconciliation Act of 1990
PL: Pub.L. 105 - 33 4641 Name of Law: Placement of advance directive in medical record.
PL: Pub.L. 105 - 33 4002 Name of Law: Transitional rules for current medicare HMO program.
PL: Pub.L. 105 - 33 4001 Name of Law: Establishment of Medicare+Choice program.
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:
73 FR 47957
08/15/2008
30-day Notice:
Federal Register Citation:
Citation Date:
73 FR 63478
10/24/2008
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
4
IC Title
Form No.
Form Name
Advanced Directives (Medicare and Medicard) - BDP-718
CMS-R-10
CMS-R-10 Form 83 - Part II (Documenting Advanced Directive)
CMS-R-10 Form 83 - Part II (Policies and Procedures)
CMS-R-10 Form 83 - Part II (Developing Advanced Directive)
CMS-R-10 Form 83 - Part II (Annual Update)
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
20,378,336
33,096
0
20,345,240
0
0
Annual Time Burden (Hours)
1,178,927
924,120
0
254,807
0
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 [PPACA, P.L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Act [Dodd-Frank Wall Street Reform and Consumer Protection Act, P.L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Agency Contact:
William Parham 4107864669
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:
10/31/2008
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