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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:
0938-0941
ICR Reference No:
201205-0938-008
Status:
Historical Active
Previous ICR Reference No:
200809-0938-015
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool ("PAT")
Type of Information Collection:
Reinstatement without change of a previously approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
07/16/2012
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/22/2012
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2015
36 Months From Approved
Responses
10
0
0
Time Burden (Hours)
790
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
The Performance Assessment Tool ("PAT) is being used to collect clinical quality measure information. It is not an electronic health record but rather a tool for collecting 'numerator' and 'denominator' information that is used to calculate performance measures on specific clinical quality measures. The tool is currently approved for use in the Physician Group Practice Demonstration (PGP), a congressionally mandated demonstration that will continue data collection past the current expiration date and through September 2013.
Authorizing Statute(s):
PL:
Pub.L. 108 - 173 649
Name of Law: MCMP Demonstration - Medicare Prescription Drug Improvement and Modernization Act of 2003
US Code:
42 USC 1395b-1
Name of Law: EHR Demonstration
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:
77 FR 13337
03/06/2012
30-day Notice:
Federal Register Citation:
Citation Date:
77 FR 29645
05/18/2012
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
Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - MCMP Demonstration
CMS-10136
MCMP PAT
Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - PGP Demonstration
CMS-10136, CMS-10136
PGP_TD-PAT_Screen_ShotsJH
Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) -EHR Demonstration
CMS-10136
MCMP PAT
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
10
0
0
10
0
0
Annual Time Burden (Hours)
790
0
0
790
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:
The burden increase is due to the reinstatement of the collection. However, none of the burden per task has changed since the original collection.
Annual Cost to Federal Government:
$906,202
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]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
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:
05/22/2012
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