EVALUATION OF THE ADMINISTRATION COMPLIANCE COST AND THE IMPACT OF THE INFLATION FACTOR FOR TITLES VI AND XVI ASSISTED FACILTIES

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
110240	EVALUATION OF THE ADMINISTRATION COMPLIANCE COST AND THE IMPACT OF THE INFLATION FACTOR FOR TITLES VI AND XVI ASSISTED FACILTIES	Migrated

ICR Details

OMB Control No: 0915-0076	ICR Reference No: 198309-0915-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: EVALUATION OF THE ADMINISTRATION COMPLIANCE COST AND THE IMPACT OF THE INFLATION FACTOR FOR TITLES VI AND XVI ASSISTED FACILTIES
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/22/1983
	Date Received in OIRA: 09/27/1983
Terms of Clearance: THIS COLLECTION IS APPROVED PROVIDING THE FOLLOWING CONDITIONS ARE MET 1.QUESTIONS 30,38,39,AND 40 FROM THE IMPACT EVALUATION SHALL BE INCORPORATED INTO THIS COLLECTION AS DESCRIBED IN THE VAN NOSTRAND MEMO OF NOVEMBER 6, 1983. 2.A QUESTION DIRECTED TOWARDS DETERMINING RESPONDENT SATISFACTIION WITH THE FOLLOWING SHOULD BE ADDED...PRECISE ELIGIBILITY CRITERIA, 3 YEAR REPORTING, ELIMINATION OF PRE-SERVICE ELIGIBILITY DETERMIN ATION, REPLACING OPEN-DOOR COMPLIANCE WITH AN OBLIGATION EQUALLY SHARED AMONG ALL FACILITIES, EXCESS COMPLIANCE AND DEFICIT MAKE UP, AND DEFICIT FORGIVENESS. 3.UNDER SECTION I, QUESTION 4 SHOULD BE REVISED TO READ...4.A. WHAT WAS YOUR ANNUAL BASE COMPLIANCE LEVEL IN DOLLARS, FOR THE MOST RECENTLY COMPLETED FISCAL YEAR, i.e.,THE TOTAL AMOUNT OF UNCOMPEN SATED CARE THAT YOUR FACILITY WAS TO PROVIDE IN THAT YEAR [HRSA 710 SUPPLEMENT A, PART A, LINE 6 OR SUPPLEMENT A, PART B, LINE 15 ...4.B. WHAT WAS YOUR ADJUSTED ANNUAL COMPLIANCE AMOUNT AFTER APPLY ING EXCESSES OR DEFICITS [HRSA 710, SUPPLEMENT A, PART A, LINE 8 OR SUPPLEMENT A, PART B, LINE 17]. 4.UNDER SECTION I, QUESTION 5 SHOULD BE REVISED TO READ...5.A.DURING THE MOST RECENTLY COMPLETED FISCAL YEAR, HOW MUCH HILL-BURTON UNCOMPENSATED CARE WAS PROVIDED AT UNUSUAL CHARGES [HRSA 710, PART C, LINE 12A]... [CONTINUED ON ATTACHMENT A]

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/1984	09/30/1984
Responses	500	0	0
Time Burden (Hours)	750	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: THE PURPOSES OF THIS STUDY ARE TO PROVIDE ANSWERS TO THE FOLLOWING QUESTIONS: 1. WHAT ARE THE ADMINISTRATIVE COSTS INCURRED BY TITLES VI AND XVI ASSISTED FACILITIES COMPLYING WITH TITLE XVI (42 CFR PART 124) AND 2. WHAT IS THE IMPACT OF THE INFLATION FACTOR ON COMPLIANCE BY THE FACILITIES?

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
EVALUATION OF THE ADMINISTRATION COMPLIANCE COST AND THE IMPACT OF THE INFLATION FACTOR FOR TITLES VI AND XVI ASSISTED FACILTIES

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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	500	0	0	500	0	0
Annual Time Burden (Hours)	750	0	0	750	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:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 09/27/1983

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