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View ICR - OIRA Conclusion

OMB Control No: 0938-1029	ICR Reference No: 201509-0938-005
Status: Historical Active	Previous ICR Reference No: 201206-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-10221
Title: Worksheet for Recording Results of Medicare Site Visits of Independent Diagnostic Testing Facilities (IDTFs) (CMS-10221)
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 with change	Conclusion Date: 10/05/2016
	Date Received in OIRA: 09/11/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2019	36 Months From Approved
Responses	900	0	0
Time Burden (Hours)	1,800	0	0
Cost Burden (Dollars)	0	0	0

Authorizing Statute(s): PL: Pub.L. 105 - 33 4313 Name of Law: BBA of 1997
   PL: Pub.L. 104 - 134 31001 Name of Law: The Debt Collection Improvement Act of 1996
   US Code: 42 USC 1395f Name of Law: Requirement of Requests and Certifications
   US Code: 42 USC 1395g Name of Law: PAYMENT TO PROVIDERS OF SERVICES
   US Code: 42 USC 1395l Name of Law: Payment of Benefits
   US Code: 42 USC 1395u Name of Law: PROVISIONS RELATING TO THE ADMINISTRATION OF PART B
   US Code: 42 USC 1395m Name of Law: SPECIAL PAYMENT RULES FOR PARTICULAR ITEMS AND SERVICES
   US Code: 42 USC 1395cc Name of Law: AGREEMENTS WITH PROVIDERS OF SERVICES; ENROLLMENT PROCESSES

Citations for New Statutory Requirements: None

ICR Summary of Burden

	Total Approved	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	900	-1,100	2,000
Annual Time Burden (Hours)	1,800	-2,200	4,000
Annual Cost Burden (Dollars)	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: The previously approved total annual hour burden for the respondents in 2012 was 2,000 hours. That figure was based on an estimation gathered from the appropriate contractors and has now been determined to be high, due to the current lesser number of respondents. In 2012, our reported estimation was 1,000 respondents at 2 hours each equaling 2,000 hours. Due to better reporting methods and more accurate data collection, CMS now determines the total burden hours for this information collection to be 1,800 hours with 900 respondents.

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