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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:
0938-0701
ICR Reference No:
201208-0938-008
Status:
Historical Active
Previous ICR Reference No:
201008-0938-023
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Medicare Health Outcomes Survey (HOS) and Supporting Regulations at 42 CFR 422.152
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:
11/07/2012
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/15/2012
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2015
36 Months From Approved
01/31/2014
Responses
666,120
0
1,099,560
Time Burden (Hours)
219,820
0
366,520
Cost Burden (Dollars)
0
0
0
Abstract:
The Centers for Medicare & Medicaid Services collects quality performance measures in order to hold the Medicare managed care industry accountable for the care being delivered, to enable quality improvement, and to provide quality information to Medicare beneficiaries in order to promote an informed choice. It is critical to CMS's mission that we collect and disseminate information that can be used to help beneficiaries choose among health plans, contribute to improved quality of care through identification of improvement opportunities, and assist CMS in carrying out its oversight and purchasing responsibilities.
Authorizing Statute(s):
PL:
Pub.L. 108 - 173 722(a)(3)(A)(i)
Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act
US Code:
42 USC 442, Subpart D
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:
77 FR 47850
08/10/2012
30-day Notice:
Federal Register Citation:
Citation Date:
77 FR 25181
04/27/2012
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
Medicare Health Outcomes Survey (HOS) and Supporting Regulations 42 CFR 422.152
CMS-10203, CMS-10203
Medicare HOS 2013 Questionnaire (English)
,
Medicare HOS-Modified 2013 Questionnaire (English)
Medicare Health Outcomes Survey (HOS) and Supporting Regulations at 42 CFR 422.152 (CMS-10203)
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
666,120
1,099,560
0
-433,440
0
0
Annual Time Burden (Hours)
219,820
366,520
0
-146,700
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:
Over the past five years the overall baseline response rate has fallen short of the 70% target. This is not saying that all plan by plan baseline response rates were below 70%, but that as a whole the overall baseline response rate has fallen below 70% consistently over the past five years. Drastically increasing respondent burden has adverse implications to future response rates so adjustments to the sampling methodology were developed to moderately increase the number of responses where appropriate and eliminate the burden where prudent.
Annual Cost to Federal Government:
$2,415,500
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]?
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:
08/15/2012
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