Hme Health Advance Beneficiary Notices (HHABNs) and Supporting Regulations in 42 CFR, Sections 411.404-.406, and 484.10\

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
8540	Hme Health Advance Beneficiary Notices (HHABNs) and Supporting Regulations in 42 CFR, Sections 411.404-.406, and 484.10\ Form	Migrated

ICR Details

OMB Control No: 0938-0781	ICR Reference No: 200004-0938-004
Status: Historical Inactive	Previous ICR Reference No: 199909-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Hme Health Advance Beneficiary Notices (HHABNs) and Supporting Regulations in 42 CFR, Sections 411.404-.406, and 484.10\
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Disapproved and continue	Conclusion Date: 06/16/2000
	Date Received in OIRA: 04/18/2000
Terms of Clearance: The proposed revisions to the HHABN are disapproved, and the existing clearance is extended through 9/30/2000. OMB recognizes the progress HCFA has made in responding to the di verse, and sometimes conflicting, public concerns and comments it has received regarding the HHABN. However, the latest round of public comments continues to express significant concerns. HHS is scheduled to implement HHA PPS on October 1, 2000, which will require additional form and process revisions. Thus, the currently proposed version of the HHABN will have limited practi- cal utility, and additional consultations with the public will be helpful in developing a new HHABN to be used when the HHA PPS goes into effect. In the interest of moving this process forward, OMB and HCFA will meet with interested commenters in July 2000 to further delineate concerns expressed in the public comments and to discuss a design framework for a new interim HHABN to be used under the HHA PPS. After consultations, HCFA must resubmit the revised HHABN for OMB review and public comment.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2000	09/30/2000	01/31/2001
Responses	360,000	0	360,000
Time Burden (Hours)	60,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Home Health Agencies must provide proper written notice to Medicare beneficiaries in advance of furnishing what they believe to be noncovered care or of reducng or terminating ongoing care.

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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
Hme Health Advance Beneficiary Notices (HHABNs) and Supporting Regulations in 42 CFR, Sections 411.404-.406, and 484.10\	HCFA-R-296

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Burden increases because of Program Change due to Agency Discretion: No

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? No

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: 04/18/2000

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