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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:
0938-0971
ICR Reference No:
201702-0938-009
Status:
Historical Active
Previous ICR Reference No:
201309-0938-026
Agency/Subagency:
HHS/CMS
Agency Tracking No:
20581
Title:
(CMS-10116) Medicare Program: Conditions of Payment of Power Mobility Devices, Including Power Wheelchairs and Power-Operated Vehicles
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:
08/16/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/24/2017
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2020
36 Months From Approved
08/31/2017
Responses
72,500
0
173,810
Time Burden (Hours)
16,917
0
34,762
Cost Burden (Dollars)
0
0
0
Abstract:
This collection requires physicians or treating practitioners to provide a written prescription and supporting documentation, including pertinent parts of the beneficiary's medical record to suppliers. This collection also requires the supplier to maintain the prescription and the supporting documentation provided by the physician or treating practitioners and makes them available to CMS and its agents upon request.
Authorizing Statute(s):
US Code:
42 USC 1395(l)
Name of Law: Payment of benefits
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:
81 FR 89104
12/09/2016
30-day Notice:
Federal Register Citation:
Citation Date:
82 FR 11037
02/17/2017
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Medicare Program: Conditions of Payment of Power Mobility Devices, Including Power Wheelchairs and Power-Operated Vehicles
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
72,500
173,810
0
-101,310
0
0
Annual Time Burden (Hours)
16,917
34,762
0
-17,845
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
Estimates of burden presented in this PRA package differ from those of previous PRA packages due to differences in the estimated total number claims submitted for payment as well as changes in reimbursement rates. For example, the previous CMS calculation estimated 173,810 submitted claims in 2012. For this package, CMS estimates that 72,500 claims will be submitted for payment in 2016, which translates into a reduction of 20,262 hours from the prior estimates.
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]?
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:
Denise King 410 786-1013 Denise.King@cms.hhs.gov
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:
02/24/2017
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