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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:
0938-1260
ICR Reference No:
201407-0938-015
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Improving Quality of Care in Medicaid and CHIP through Increased Access to Preventive Services, State Survey (CMS-10521)
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
11/19/2014
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/25/2014
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2017
36 Months From Approved
Responses
51
0
0
Time Burden (Hours)
128
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
In 2014, CMS plans to conduct a survey of state Medicaid directors that focuses on state coverage of preventive services. The survey is to establish a baseline of covered preventive services by states, to better understand whether incentives impact state coverage of preventive services and to identify which methods of outreach and education are most beneficial to recipients. The collection is critical to the mission of CMS.
Authorizing Statute(s):
PL:
Pub.L. 111 - 148 4106
Name of Law: Patient Protection and Affordable Care Act/HealthCare and Education Reconciliation Act of 2010
PL:
Pub.L. 111 - 152 1302(b)
Name of Law: Patient Protection and Affordable Care Act/HealthCare and Education Reconciliation Act of 2010
Citations for New Statutory Requirements:
PL: Pub.L. 111 - 148 4106 Name of Law: Patient Protection and Affordable Care Act/HealthCare and Education Reconciliation Act of 2010
PL: Pub.L. 111 - 152 1302(b) Name of Law: Patient Protection and Affordable Care Act/HealthCare and Education Reconciliation Act of 2010
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:
79 FR 20211
04/11/2014
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 43474
07/25/2014
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Preventive Services in Medicaid Survey
CMS-10521
Preventive Services in Medicaid Survey
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
51
0
51
0
0
0
Annual Time Burden (Hours)
128
0
128
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:
This is a new colelction. One comment letter was received during the 60-day comment period; our response has been added to this PRA package. While, the burden remains unchanged we added three questions in response to the comments. We do not believe that the added questions warrant any burden adjustments.
Annual Cost to Federal Government:
$112,876
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]?
Yes
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:
Mitch Bryman 410 786-5258 Mitch.Bryman@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:
07/25/2014
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