Durable Medical Equipment Regional Carrier, Certificate of Medical Necessity

ICR 200207-0938-006

OMB: 0938-0679

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0679 200207-0938-006
Historical Active 199703-0938-002
HHS/CMS
Durable Medical Equipment Regional Carrier, Certificate of Medical Necessity
Reinstatement without change of a previously approved collection   No
Regular
Approved with change 09/13/2002
Retrieve Notice of Action (NOA) 07/10/2002
Approval for this information collection request is being renewed for a period of three months. During the review period, OMB and the agency have begun discussions about possible modifications to the CMN form(s) and the agency has also undertaken its own review. In light of this ongoing interagency discussion and agency review, and the possibility that they will result in proposed modifications to the form(s), CMS is being given a three month approval. If the current discussion and review results in significant proposed changes to the form(s), then the agency will seek public comment on any resulting proposed changes to the CMN via the Federal Register, as established in the Paperwork Reduction Act. The agency must also resubmit this collection to OMB for approval prior to its expiration. Because compliance with these public comment and OMB review procedures would require additional time, OMB will reassess the status of the interagency discussion and agency review near the end of this 90-day approval period, and we will determine the appropriate action to take with respect to an extension of the current approval. OMB also notes that this collection (0938-0679) no longer contains the CMN form for power wheelchairs. The CMN form for power wheelchairs is now approved as a new collection under OMB number 0938-0875.
  Inventory as of this Action Requested Previously Approved
12/31/2002 12/31/2002
6,700,000 0 0
1,130,000 0 0
0 0 0

This information is needed to correctly process claims and ensure that claims are properly paid. These forms contain medical information necessary to make an appropriate claim determination. Suppliers and physicians will complete these forms.

None
None


No

1
IC Title Form No. Form Name
Durable Medical Equipment Regional Carrier, Certificate of Medical Necessity CMS-841, CMS-842, CMS-844, CMS-853

  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 6,700,000 0 0 6,700,000 0 0
Annual Time Burden (Hours) 1,130,000 0 0 1,130,000 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.
07/10/2002


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