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:
0938-0568
ICR Reference No:
199702-0938-006
Status:
Historical Active
Previous ICR Reference No:
199702-0938-004
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Computerized Automated Personal Interviewing (CAPI) Conversion of the Medicare Current Beneficiary Survey (MCBS) Facility Questionnaire (CAPI Conversion of MCBS Facility Questionnaire)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
04/26/1997
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/20/1997
Terms of Clearance:
The MCBS Facility quesionnaire and CAPI conversion are approved for use through 9/98 under the following conditions: 1) HCFA understands that this clearance action does not apply to other MCBS components, including the MCBS supplement recently approved through 8/97 on an emergency basis; 2) the next submission for review under this OMB number 0938-0568 contains all components of the MCBS currently fielded; 3) HCFA immediately incorporates the new dislosure statements mandated by the Paperwork Reduction Act of 1995. For the public record, HCFA submits to OMB the revised forms/instructions; 4) prior to the next submission, HCFA, NCHS, and AHCPR brief OMB on continuing departmental efforts to inte- grate nursing home surveys; and 5) prior to fielding this CAPI instrument, HCFA clarifies which issues referenced in the WESTAT memos dated 6/19/96 and 6/6/96 are resolved or remain unresolved pending future negotiations and refinements. In response to these clarifications, OMB may request additional amendments to this instrument.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/1998
09/30/1998
08/31/1997
Responses
1,900
0
16,000
Time Burden (Hours)
16,000
0
16,000
Cost Burden (Dollars)
0
0
0
Abstract:
Adaptation of the MCBS can be broken down into two separate parts: (A) conversion of the facility interview from a hard-copy questionnaire to a CAPI format beginning in May, 1997. CAPI, which the MCBS currently employs in the community interview, increases the accuracy of the interview process by automating skip patterns, customizing questions, creating computed variables such as a time line of residence history, and automatically checking completeness and consistency of responses. (B) Modification to some of the questions that are currently used in the facility interview to make them more comparable.....
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
Computerized Automated Personal Interviewing (CAPI) Conversion of the Medicare Current Beneficiary Survey (MCBS) Facility Questionnaire (CAPI Conversion of MCBS Facility Questionnaire)
HCFA-P-15A
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
1,900
16,000
0
-14,100
0
0
Annual Time Burden (Hours)
16,000
16,000
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?
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]?
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:
02/20/1997
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