Medicare ESRD Exceptions

ICR 200704-0938-002

OMB: 0938-0296

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
0000-00-00
IC Document Collections
IC ID
Document
Title
Status
7947
Modified
ICR Details
0938-0296 200704-0938-002
Historical Active 200401-0938-008
HHS/CMS
Medicare ESRD Exceptions
Revision of a currently approved collection   No
Regular
Approved without change 08/23/2007
Retrieve Notice of Action (NOA) 04/15/2007
  Inventory as of this Action Requested Previously Approved
08/31/2010 36 Months From Approved 08/31/2007
10 0 125
400 0 6,000
0 0 0

Sections 2721, 2722 and 2725 of the Provider Reimbursement Manual describes the information End Stage Renal Disease facilities must submit in justifying an exception request to their composite rate for outpatient dialysis services.

PL: Pub.L. 108 - 173 623 Name of Law: MMA
  
None

Not associated with rulemaking

  72 FR 3852 01/26/2007
72 FR 17169 04/06/2007
No

1
IC Title Form No. Form Name
Medicare ESRD Exceptions

  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 10 125 0 -115 0 0
Annual Time Burden (Hours) 400 6,000 0 -5,600 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Changing Regulations
In accordance with changes made by section 422 of BIPA 2000 and section 623 of the MMA. The major changes are; (a) Only a pediatric ESRD facility that did not have an approved exception rate as of October 1, 2002 can now file for an exception to its updated composite payment rate

$34,200
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Saleda Perryman

  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.
04/15/2007


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