Data Collection for the Second Generation Social Health Maintenance Organization Demonstration

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-R-204 Data Collection for the Second Generation Social Health Maintenance Organization Demonstration	Form and Instruction	Modified	Available
Supporting Statement Attahment B.doc	Supporting Statement B	Uploaded 0000-00-00	Available
CMS-R-204-SST250r2.doc	Supporting Statement A	Uploaded 0000-00-00	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8352	Data Collection for the Second Generation Social Health Maintenance Organization Demonstration	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0709	ICR Reference No: 200702-0938-006
Status: Historical Active	Previous ICR Reference No: 200401-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Data Collection for the Second Generation Social Health Maintenance Organization Demonstration
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/06/2007
	Date Received in OIRA: 02/20/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2009	36 Months From Approved	06/30/2007
Responses	17,624	0	15,000
Time Burden (Hours)	3,525	0	3,000
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Medicare & Medicaid Services will continue to use the data collected under this effort to support the operational needs of the Congressionally-mandated and administratively extended Second Generation of the Social Health Maintenance Organization Demonstration.

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Authorizing Statute(s): PL: Pub.L. 103 - 66 5079 Name of Law: Omnibus Budget Reconciliation Act
   PL: Pub.L. 105 - 33 4014 Name of Law: Balanced Budget Act
   PL: Pub.L. 106 - 113 531 Name of Law: Balanced Budget Refinement Act
   PL: Pub.L. 106 - 554 631 Name of Law: Benefits Improvement and Protection Act
   PL: Pub.L. 98 - 369 2355 Name of Law: Deficit Reduction Act
   PL: Pub.L. 100 - 203 4018(b) Name of Law: Omnibus Budget Reconciliation Act
   PL: Pub.L. 101 - 508 4207(b)(4) Name of Law: Omnibus Budget Reconciliation Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 63018	10/27/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 1537	01/12/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Data Collection for the Second Generation Social Health Maintenance Organization Demonstration	CMS-R-204	Second Generation Social HMO Organization Demonstration

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ICR Summary of Burden

table that charts list 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	17,624	15,000	0	0	2,624	0
Annual Time Burden (Hours)	3,525	3,000	0	0	525	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: $1,142,564

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: 02/20/2007

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