END STAGE RENAL DISEASE (ESRD) MEDICAL CASE REVIEW

ICR 199011-0938-003

OMB: 0938-0574

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
114009 Migrated
ICR Details
0938-0574 199011-0938-003
Historical Active
HHS/CMS
END STAGE RENAL DISEASE (ESRD) MEDICAL CASE REVIEW
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 02/28/1991
Retrieve Notice of Action (NOA) 11/29/1990
Approved for use as a pilot with the understanding that this clearance covers only the ESRD medical criteria and does not pertain to the following requirements omitted from this submission: 1) supplementary medical review protocols 2) sampling methodology and screens for focused review of ESRD facilities and 3) followup requests based on facility response to the medical criteria. OMB requested additional information on these requirements, and HCFA failed to respond. So OMB can fully evaluate the practical utility in meeting OBRA 86, HCFA should include these requirements in the next submission.
  Inventory as of this Action Requested Previously Approved
02/28/1992 02/28/1992
216 0 0
3,456 0 0
0 0 0

SECTION 1881(C)(2)(E) & (F) OF THE SOCIAL SECURITY ACT REQUIRES END STAGE RENAL DISEASE (ESRD) NETWORK ORGANIZATIONS TO PERFORM REVIEW OF ESRD FACILITIES, UTILIZING DEFINED STANDARDS OF CAREER TO ASSURE THAT ESRD BENEFICIARIES RECEIVE PROPER MEDICAL CARE.

None
None


No

1
IC Title Form No. Form Name
END STAGE RENAL DISEASE (ESRD) MEDICAL CASE REVIEW HCFA-R-1

  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 216 0 0 216 0 0
Annual Time Burden (Hours) 3,456 0 0 3,456 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.
11/29/1990


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