Statement of Deficiencies and Plan of Correction

ICR 199608-0938-009

OMB: 0938-0391

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
8034 Migrated
ICR Details
0938-0391 199608-0938-009
Historical Active 199605-0938-006
HHS/CMS
Statement of Deficiencies and Plan of Correction
Extension without change of a currently approved collection   No
Regular
Approved without change 11/05/1996
Retrieve Notice of Action (NOA) 08/27/1996
Approved for use through 11/98 under the condition that HCFA immediately incorporates the disclosure statements mandated by the Paperwork Reduction Act of 1995. HCFA must submit to OMB the revised forms/instructions for the public record. Also, OMB notes that this approval will expire in two years to coincide with the 1998 certification/recertification cycle for OPOs, and to ensure consistency with any amendments subsequently made to the final rules published on 5/2/96.
  Inventory as of this Action Requested Previously Approved
11/30/1998 11/30/1998 10/31/1996
98,400 0 98,400
196,800 0 196,800
0 0 0

This paperwork package provides information regarding deficiencies for Organ Procurement Organizations (OPO), as well as deficiencies noted during periodic facility and laboratory certification surveys. This information is used to make decisions concerning OPO redesignation, certification/recertification of health care facilities participating in the Medicare/Medicaid programs, and laboratories regulated by CLIA.

None
None


No

1
IC Title Form No. Form Name
Statement of Deficiencies and Plan of Correction HCFA-2567-A

  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 98,400 98,400 0 0 0 0
Annual Time Burden (Hours) 196,800 196,800 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
08/27/1996


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