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:
0938-1299
ICR Reference No:
201712-0938-006
Status:
Historical Active
Previous ICR Reference No:
201507-0938-005
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
(CMS-10539) Medicare and Medicaid Programs: Conditions of Participation for Home Health Agencies (HHA)
Type of Information Collection:
Existing collection in use without an OMB Control Number
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
02/22/2018
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/08/2017
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2021
36 Months From Approved
Responses
40,135,877
0
0
Time Burden (Hours)
4,462,295
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
Home health agencies are required to maintain certain documentation within their own agency records that demonstrates compliance with specific Conditions of Participation for the Medicare program. This documentation is maintained on-site for use in the home health agency survey process.
Authorizing Statute(s):
PL:
Pub.L. 101 - 239 6005(b)
Name of Law: Omnibus Reconciliation Act of 1989
US Code:
42 USC 1395X
Name of Law: Social Security Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AG81
Final or interim final rulemaking
82 FR 4504
01/13/2017
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
19
IC Title
Form No.
Form Name
484.100(a) - existing
484.100(a) - new agencies
484.105(h)
484.105(h) - existing
484.110(a) - content of clinical records
484.50(a) existing agencies
484.50(a) new agencies
484.50(e)
484.60(a)
484.60(a) care planning
484.60(c)
484.60(e)
484.65(d)
484.65(e) - quality assessment and performance
484.70
484.80(a)
484.80(b) - home health aide classroom and practical training
484.80(c) - compentency evaluation
484.80(d) - in-service training
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
40,135,877
0
0
7,154,820
0
32,981,057
Annual Time Burden (Hours)
4,462,295
0
0
1,679,671
0
2,782,624
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:
This is a new information collection that is necessary due to the complete reorganization and revision of the CoPs.
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]?
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:
12/08/2017
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