View Information Collection Request (ICR) Package

OMB Control No: 0938-0723	ICR Reference No: 200101-0938-004
Status: Historical Active	Previous ICR Reference No: 199912-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Integrity Program Organizations Conflict of Interest Disclosure Certificate and Supporting Regulations at 42 CFR 421.300 - 421.318
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: 04/17/2001
	Date Received in OIRA: 01/25/2001
Terms of Clearance: This information collection request is approved consistent with previous terms of clearance which condition approval upon HCFA's agreement to address privacy issues pertaining to MIP contractor access to patient data and medical records in its final rule. HCFA must either articulate more detailed policies in the regulatory text or explain in the final rule's preamble how these issues will be monitored through the contractor process. The clearance period for this collection has been abreviated to enable OMB to monitor's HCFA's progress. Additionally, as agreed in HCFA's 3/29/01 memo, the OMB number for this collection will be included in the final rule. Furthermore, OMB expects HCFA to continue to enhance respondents' options to submit this requested information electronically.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2002	10/31/2002	04/30/2001
Responses	10	0	10
Time Burden (Hours)	2,400	0	2,400
Cost Burden (Dollars)	0	0	0

Abstract: HCFA needs this information to assess whether contractors who perform, or who seek to perform, Medicare Integrity Program functions, such as medical review, fraud review or cost audits, have organizational conflicts of interest and whether any conflicts have been resolved. The entities providing the information will be organizations that have been awarded, or seek award of, a Medicare Integrity Program contract.

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

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	10	10
Annual Time Burden (Hours)	2,400	2,400
Annual Cost Burden (Dollars)	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

View ICR - OIRA Conclusion