Field Testing of the Uniform Needs Assessment Instrument (UNAI): Small-Scale Trial Phase 2

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
8269	Field Testing of the Uniform Needs Assessment Instrument (UNAI): Small-Scale Trial Phase 2 Form	Migrated

ICR Details

OMB Control No: 0938-0680	ICR Reference No: 199904-0938-006
Status: Historical Active	Previous ICR Reference No: 199510-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Field Testing of the Uniform Needs Assessment Instrument (UNAI): Small-Scale Trial Phase 2
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/01/1999
	Date Received in OIRA: 04/26/1999
Terms of Clearance: Approved for use through 7/2002 under the condition that HCFA continues to refine this instrument to enhance its consistency and practical utility in use with the MDS and OASIS. No later than July 1999, HCFA must submit to OMB a plan for achieving these objectives, with a particular emphasis on coordination with OASIS. In addition, HCFA must submit to OMB a report on issues pertaining to patient item (i.e. sensitive questions) and general nonresponse. This report must provide recommendations (in regard to patient notifications, surveyor guidance, etc.) that will be more relevant as the UNAI is implemented more extensively and integrated into day-to-day patient care and broader Medicare/Medicaid policy.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2002	07/31/2002
Responses	720	0	0
Time Burden (Hours)	847	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This Small-Scale Trial Phase 2 involves data collection activities testing the validity (clinical utility), reliability, and administrative feasibility of a revised Uniform Needs Assessment Instrument (UNAI). The instrument includes a high-risk screener to identify acute care hospital patients who have post-acute care needs and require extensive discharge planning. Hospital discharge planners will conduct patient assessment interviews using the instrument and will offer their views on the clinical utility of the instrument, as well as the relevance of the assessment protocols and training materials.

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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
Field Testing of the Uniform Needs Assessment Instrument (UNAI): Small-Scale Trial Phase 2	HCFA-R-180

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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	720	0	0	720	0	0
Annual Time Burden (Hours)	847	0	0	847	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? Yes Part B of Supporting Statement

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: 04/26/1999

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