View Information Collection Request (ICR) Package

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: 0938-1140	ICR Reference No: 201809-0938-009
Status: Historical Active	Previous ICR Reference No: 201805-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: Skilled Nursing Facility (SNF) Minimum Data Set (MDS) 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) Item Sets (NP, NO/SO, NS, NOD, NSD) (CMS-10387)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/12/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/11/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2022	36 Months From Approved	02/29/2020
Responses	4,905,042	0	6,563,344
Time Burden (Hours)	4,169,286	0	5,580,885
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	4,905,042	6,563,344	-2,029,606	371,304
Annual Time Burden (Hours)	4,169,286	5,580,885	-1,727,207	315,608
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: Changing Regulations

Short Statement: In past calculations of PPS assessments (April 2017 Supporting Statement), we did not include the PPS discharge assessment in our counts because, while a required assessment, it was not originally created or used for payment purposes and thus was exempt from PRA consideration. However, because we are requiring the PPS discharge assessment a for payment purposes, as outlined in CMS-1696-F, we believe that the past counts (April 2018- RUG-IV) are relevant to the burden and cost estimates for PDPM. Thus, we are including these assessments in our calculations. There will be a decrease in total number of responses because we will no longer require all of the PPS assessments currently required. Similarly, the total annual hour burden estimate is decreased because of the reduced number of assessments.

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: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov