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:
0990-0330
ICR Reference No:
202103-0990-004
Status:
Historical Active
Previous ICR Reference No:
201709-0990-001
Agency/Subagency:
HHS/HHSDM
Agency Tracking No:
Title:
OMHA Annual Appellant Climate Survey
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
06/29/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/26/2021
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2024
36 Months From Approved
08/31/2021
Responses
800
0
400
Time Burden (Hours)
200
0
100
Cost Burden (Dollars)
0
0
0
Abstract:
The Office of Medicare Hearings and Appeals (OMHA)requests a three year programmatic clearance from the OMB to conduct customer research through external surveys by means of telephone interviews and web-based suveys. The proposed information collection request covers all types of OMHA appellants, with a primary focus on the three appellant types who receive benefits from OMHA-beneficiares, providers, and suppliers.
Authorizing Statute(s):
US Code:
42 USC 301
Name of Law: Public Health Service Act
EO: EO 12862 Name/Subject of EO: September 11, 1993
Citations for New Statutory Requirements:
None
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:
86 FR 10587
02/22/2021
30-day Notice:
Federal Register Citation:
Citation Date:
86 FR 26738
05/17/2021
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
2
IC Title
Form No.
Form Name
Beneficiaries
Health Care Providers and Suppliers
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
800
400
0
400
0
0
Annual Time Burden (Hours)
200
100
0
100
0
0
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:
The number of respondents has been increased in this upcoming data collection cycle. As new field offices have been created and staffed to fulfill the increase in Medicare appeals, the targeted number of completed surveys increased from 400 in the previous cycle to 800 in each FY of the upcoming data collection cycle. This increase in sample size will provide data for process improvements in each field office for the purpose of improving the Medicare appellants’ customer experience. The estimated number of burden hours is 200 burden hours for each FY.
Annual Cost to Federal Government:
$30,301
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
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?
No
Agency Contact:
Renee Johnson 571 777-2741 renee.johnson@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:
05/26/2021
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