View Information Collection Request (ICR) Package
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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:
0938-0579
ICR Reference No:
201104-0938-005
Status:
Historical Active
Previous ICR Reference No:
200605-0938-005
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Business Proposal Forms For Quality Improvement Organizations (QIOs)
Type of Information Collection:
Reinstatement with change of a previously approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
07/24/2011
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/26/2011
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2014
36 Months From Approved
Responses
21
0
0
Time Burden (Hours)
1,785
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
The submission of proposal information by current Quality Improvement Organizations and other bidders on the appropriate forms will satisfy CMS' need for meaningful, consistent, and verifiable data, which aids Federal procurement awards.
Authorizing Statute(s):
US Code:
42 USC 1320c-3
Name of Law: Functions of Peer Review Organizations
US Code:
42 USC 1395ww
Name of Law: Payment to Hospitals for Inpatient Hospital Services
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:
75 FR 2547
01/15/2010
30-day Notice:
Federal Register Citation:
Citation Date:
75 FR 15435
03/28/2010
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
Business Proposal Forms For Quality Improvement Organizations (QIOs)
CMS 718-721, CMS 718-721, CMS-718-721, CMS-718-721, CMS-718-721
CMS 718-721.J-8a 9th SOW CKD Spreadsheet
,
CMS 718-721.J-8a 9th SOW Disparities Spreadsheet
,
CMS-718-721.J-8a 9th SOW Patient Pathways Spreadsheet
,
CMS-718-721.Travel Detail Chart
,
CMS-718-721.BP9SOW - Forms - OCN-0938-0579
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
21
0
0
21
0
0
Annual Time Burden (Hours)
1,785
0
0
1,785
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:
No
Burden Reduction Due to:
Short Statement:
The increase in burden is associated with an increased number of respondents.
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:
William Parham 4107864669
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:
04/26/2011
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