Medicare Lifestyle Modification Program Demonstration

ICR 200002-0938-005

OMB: 0938-0777

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
8528 Migrated
ICR Details
0938-0777 200002-0938-005
Historical Active 199907-0938-006
HHS/CMS
Medicare Lifestyle Modification Program Demonstration
Extension without change of a currently approved collection   No
Regular
Approved without change 04/21/2000
Retrieve Notice of Action (NOA) 02/10/2000
Approved as an extension without change through 4/2003. HCFA published a Federal Register notice announcing the withdrawal of this project and its amendment, however, this package does not reflect these policy changes. If HCFA expects to incorporate amendments in the future, it must resubmit this package with the changes for PRA review, and OMB will complete its review expedi- tiously.
  Inventory as of this Action Requested Previously Approved
08/31/2003 08/31/2003 04/30/2000
9,000 0 4,500
1,500 0 750
0 0 0

This demonstration will focus on Medicare sponsored, lifestyle modification programs designed to reverse, reduce, or ameliorate the progression of cardiovascular disease (CAD) of Medicare beneficiaries at risk for invasive treatment procedures. This demonstration will test the feasibility and cost effectiveness of providing payment for cardiovascular lifestyle modification program services to Medicare beneficiaries.

None
None


No

1
IC Title Form No. Form Name
Medicare Lifestyle Modification Program Demonstration HCFA-R-289

  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 9,000 4,500 0 4,500 0 0
Annual Time Burden (Hours) 1,500 750 0 750 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.
02/10/2000


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