ESRD Beneficiary Selection and Supporting Regulations Contained in 42 CFR 414.330

ICR 200411-0938-005

OMB: 0938-0372

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0372 200411-0938-005
Historical Active 200402-0938-004
HHS/CMS
ESRD Beneficiary Selection and Supporting Regulations Contained in 42 CFR 414.330
Revision of a currently approved collection   No
Regular
Approved without change 01/28/2005
Retrieve Notice of Action (NOA) 11/30/2004
  Inventory as of this Action Requested Previously Approved
01/31/2008 01/31/2008 05/31/2007
7,400 0 7,400
617 0 617
0 0 0

ESRD facilities have each new home dialysis patient select one or two methods to handle Medicare reimbursement. The intermediaries pay for the beneficiaries selecting Method I and the carriers pay for the beneficiaries selecting Method II. This system was developed to avoid duplicate billing by both intermediaries and carriers.

None
None


No

1
IC Title Form No. Form Name
ESRD Beneficiary Selection and Supporting Regulations Contained in 42 CFR 414.330 CMS-382

  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 7,400 7,400 0 0 0 0
Annual Time Burden (Hours) 617 617 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.
11/30/2004


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