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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:
0938-1071
ICR Reference No:
201911-0938-005
Status:
Historical Active
Previous ICR Reference No:
201810-0938-002
Agency/Subagency:
HHS/CMS
Agency Tracking No:
20480
Title:
(CMS-10279) Ambulatory Surgical Centers Conditions of Coverage
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
12/03/2019
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/15/2019
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2022
36 Months From Approved
08/31/2020
Responses
22,285
0
22,000
Time Burden (Hours)
262,946
0
214,500
Cost Burden (Dollars)
0
0
0
Abstract:
This information collection package is a request for extension of information collection requirements. With this submission, we have updated the current number of Ambulatory Surgical Centers and wages/salary figures. The information collection requirements, as discussed in the supporting statement, are needed to implement the Medicare and Medicaid Conditions for Coverage for 5557 Ambulatory Surgical Centers.
Authorizing Statute(s):
PL:
Pub.L. 96 - 499 934
Name of Law: Outpatient Surgery
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AT23
Final or interim final rulemaking
84 FR 51732
09/30/2019
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
5
IC Title
Form No.
Form Name
Ambulatory Surgical Centers Conditions of Coverage (416.41)
Ambulatory Surgical Centers Conditions of Coverage (416.43)
Ambulatory Surgical Centers Conditions of Coverage (416.50)(a)(1)
Ambulatory Surgical Centers Conditions of Coverage (416.50)(a)(3)
Ambulatory Surgical Centers Conditions of Coverage 416.52(a)
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
22,285
22,000
0
285
0
0
Annual Time Burden (Hours)
262,946
214,500
0
48,446
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
We have adjusted the burden estimates to reflect that the previously approved one-time burden at §416.50(a)(1) for all ASCs to develop a patient rights form will only be incurred by an estimated 57 new ASCs each year in the future. In addition, we have annualized the new one-time burden associated with 84 FR 51732 at §416.52(a) over the 3-year approval period. These changes result in a decrease of burden from 377,876 hours to 262,946 hours compared to what was proposed, or a decrease of 48,446 compared to the previous approved package (ICR Reference Number: 201704-0938-009). Refer to Table 4 for details.
Annual Cost to Federal Government:
$0
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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:
11/15/2019
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