PROVIDER REIMBURSEMENT MANUAL, PART 1, CHAPTER 27, SECTIONS 2721, 2722, AND 2725. THIS CHAPTER OF THE PRM CONTAINS THE REQUIREMENT FOR SUBMITTING AN EXECPTION TO COMPOSITE RATE
ICR 198309-0938-007
OMB: 0938-0296
Federal Form Document
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PROVIDER REIMBURSEMENT
MANUAL, PART 1, CHAPTER 27, SECTIONS 2721, 2722, AND 2725. THIS
CHAPTER OF THE PRM CONTAINS THE REQUIREMENT FOR SUBMITTING AN
EXECPTION TO COMPOSITE RATE
CHAPTER 27 OF THE PRM (HCFA PUB. 15-1)
DESCRIBES THE INFORMATION THAT END STAGE RENAL DISEASE FACILITIES
MUST SUBMIT IN JUSTIFYING AN EXCEPTION REQUEST TO THEIR COMPOSITE
RATE REIMBURSEMENT FOR OUTPATIENT DIALYSIS SERVICES.
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.