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View ICR - OIRA Conclusion

OMB Control No: 0938-1034	ICR Reference No: 201707-0938-011
Status: Historical Active	Previous ICR Reference No: 201403-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: 21556
Title: Disclosures Required Regarding Physician Ownership and On-site Availability of an MD/DO (CMS-10225)
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 with change	Conclusion Date: 02/26/2018
	Date Received in OIRA: 07/25/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved	02/28/2018
Responses	7,869,288	0	14,945,498
Time Burden (Hours)	181,505	0	333,583
Cost Burden (Dollars)	0	0	0

Authorizing Statute(s): PL: Pub.L. 106 - 224 5006 Name of Law: Development of Strategic Plan Regarding Physician Investment in Specialty Hospitals.
   PL: Pub.L. 111 - 148 6001 Name of Law: Limitation on Medicare Exception to the Prohibition on Certain Physician Referrals for Hospitals.
   US Code: 42 USC 1395x(e) Name of Law: definition of the term
   PL: Pub.L. 109 - 171 5006(a)(1) Name of Law: Deficit Reduction Act
   US Code: 42 USC 1395i-4(c) Name of Law: Medicare Ruaral Hospital Flexibility Program Described

Citations for New Statutory Requirements: None

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	7,869,288	14,945,498	-284	-7,075,926
Annual Time Burden (Hours)	181,505	333,583	-303	-151,775
Annual Cost Burden (Dollars)	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: We are adjusting our burden estimate to reflect the changes in the number of physician owned hospitals and CAHs from the previous package which was 265 compared to the current number of 81. Additionally, for CY 2016 there were changes in the number of inpatient and outpatient claims submitted to the MACs for payment from hospitals and CAHs. This current claim information was used to calculate burden associated with the estimated inpatients and outpatients that are required to receive disclosure notices. These changes decreased the estimated burden hours from 333,583 to 181,505.

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. 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: Denise King 410 786-1013 Denise.King@cms.hhs.gov

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