View Information Collection Request (ICR) Package
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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:
0938-0679
ICR Reference No:
199602-0938-003
Status:
Historical Active
Previous ICR Reference No:
199510-0938-001
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Durable Medical Equipment Regional Carrier, Certificates of Medical Necessity
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 without change
Conclusion Date:
04/15/1996
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/09/1996
Terms of Clearance:
OMB applauds HCFA for its superior professionalism, policy, analysis, and responsiveness to commenters' concerns in its PRA review and revision of the Durable Medical Equipment Certificates of Medical Necessity. HCFA's participation in the PRA process has been exemplary. However, during the OMB review process, commenters have raised several outstanding concerns that OMB believes deserve HCFA's further consideration and resolution. OMB understands that many of these concerns will require amend- ments to the National Standard Format (NSF) and perhaps to DMERC operations. The NSF electronic file structures are covered under this clearance action along with the hard copy forms. HCFA invested in the National Standard Format in January 1991 before submitting the requirements for OMB review. Therefore, revisions of the NSF shall be made consistent with the objectives of the Paperwork Reduction Act of 1995. OMB approves for use the revised CMNs through 4/97 under the following conditions: 1) No later than 12/96, HCFA develops a third one page wheelchair CMN to cover "standard" wheelchairs. "Standard" wheelchairs are defined as manual wheelchairs in HCPCS codes K0001, K0002, K0003, and K0004 and with 3 or less accessories; 2) HCFA allows for private sector automation of the CMNs (in particular sections B and C on the form) when the CMN information has been electronically submitted to the DMERC and the hard copy CMN is used solely for recordkeeping purposes. Without exception, the computerized versions of the form must contain identical questions/wording to the OMB-approved form in the same sequence, with the same pagination, and identical instructions/ definitions printed on the back of page one. CMN question sets may not be combined. Within these constraints, flexibility will be allowed in the computer font as articulated in OMB's later technical remarks; 3) The mandated NSF reflects the revised hardcopy CMNs and in the future HCFA better coordinates PRA oversight of the hardcopy forms and related electronic file structures; and 4) The revised CMNs and DMERC computer screens for electronic transmission display the OMB clearance number and disclosure statements as required by the Paperwork Reduction Act of 1995 and 5 CFR 1320. Technical Comments . To ensure that the programmatic objectives of CMNs are met, CMNs may be computer generated if: 1) without exception, they meet the requirements of item 2 above; and 2) are printed within the font specifications recommended by commenters (see DEZINE HEALTHCARE SOLUTIONS letter to NAMES dated 4/10/96, forwarded to OMB on 4/11/96) and agreed to by HCFA. In addition, to ensure adequate industry reproduction, the computer generated CMNs should meet the enclosed HCFA specifications; and . Computer generated instructions appropriate for a particular CMN may appear in entirety on the back side of the first page consistent with the above format specifications. Finally, as suggested by public commenters, OMB recommends that HCFA consider the following amendments: . In the enteral nutrition CMNs, HCFA will consider providing respondents the choice between specifying the HCPCS code or a narrative description with the appropriate level of detail (e.g. dosage, frequency, etc.) HCFA will discuss its decision on this matter and its basis in the next submission for OMB clearance; . Redesign of the CMN's Part B to include check-off blocks for "yes" and "no"; and . To allow for additional space in Part C, consolidation of questions 5-7 in the wheelchair CMNs. Pending implementation of the third streamlined wheelchair CMN, HCFA will implement all of its revised CMNs including the two page forms for manual and motorized wheelchair CMNs. HCFA actively should educate the physician/supplier community in the use of these forms and inform them that an additional streamlined wheelchair form (similar in format but on one page) will be available in the next few months.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/1997
05/31/1997
04/30/1996
Responses
6,800,000
0
6,800,000
Time Burden (Hours)
1,130,000
0
1,130,000
Cost Burden (Dollars)
0
0
0
Abstract:
This information is needed to correctly process claims and insure that claims are properly paid. These forms contain medical information necessary to make an appropriate claims determination. Suppliers and physicians will complete these forms.
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
Durable Medical Equipment Regional Carrier, Certificates of Medical Necessity
HCFA-R-182
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
6,800,000
6,800,000
0
0
0
0
Annual Time Burden (Hours)
1,130,000
1,130,000
0
0
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 [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:
02/09/1996
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