EVALUATION OF REIMBURSING FOR HOME DIALYSIS SERVICES

ICR 198103-0938-012

OMB: 0938-0162

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
113009 Migrated
ICR Details
0938-0162 198103-0938-012
Historical Active
HHS/CMS
EVALUATION OF REIMBURSING FOR HOME DIALYSIS SERVICES
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 04/02/1981
Retrieve Notice of Action (NOA) 03/23/1981
  Inventory as of this Action Requested Previously Approved
04/30/1982 04/30/1982
3,950 0 0
2,538 0 0
0 0 0

NEED: DATA COLLECTED WILL REFLECT ATTITUDES OF PATIENTS, PHYSICIANS, ESRD HOME TRAINING COORDINATORS AND HOME DIALYSIS AIDS REGARDING HOME DIALYSIS. USES: TO DETERMINE IF HOME DIALYSIS CAN BE DEFINITELY DEMONSTRATED TO BE CHEAPER AND AT THE SAME TIME NOT ADVERSELY AFFECT THE QUALITY OF CARE.

None
None


No

1
IC Title Form No. Form Name
EVALUATION OF REIMBURSING FOR HOME DIALYSIS SERVICES HCFA-191T, THRU, HCFA-196T

  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 3,950 0 0 3,950 0 0
Annual Time Burden (Hours) 2,538 0 0 2,538 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/23/1981


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