Disclosure of Financial Relationships Report ("DFRR")

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
igcepscdisclosure(2) 8-28-07.xls	Supplementary Document	Uploaded 2007-09-14	Repair queued
CMS-10236 Summary of Changes to DFRR 8-30-07 1200pm.doc	Supplementary Document	Uploaded 2007-09-14	Repair queued
CMS-10236 Comments #4 and 5.pdf	Supplementary Document	Uploaded 2007-09-14	Repair queued
CMS-10236 Comments #1,2 and 3.pdf	Supplementary Document	Uploaded 2007-09-14	Repair queued
Comments10236August30 3pm.doc	Supplementary Document	Uploaded 2007-09-14	Repair queued
CMS-10236 Supporting Statement rev 8-29-07 1100am.doc	Supporting Statement A	Uploaded 2007-09-14	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
182211	Title Disclosure of Financial Relationships Report ("DFRR") - CMS-10236	Other-DFRR Report	New

ICR Details

OMB Control No:	ICR Reference No: 200710-0938-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Disclosure of Financial Relationships Report ("DFRR")
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 04/10/2008
	Date Received in OIRA: 10/01/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 1877(f) of the Social Security Act requires that each entity providing covered services for which payment may be made shall provide the Secretary with the information concerning the entity's ownership, investment, and compensation arrangements. Section 5006 of the DRA requires us to consider the issue of annual disclosure of investment and compensation arrangements information. In the Final Report to Congress and Strategic and Implementing Plan required under this section, released August 2006, we stated that pursuant to 42 CFR section 411.361 we would require hospitals to provide us information on a periodic basis concerning their investment and compensation relationships with physicians. We are limiting our initial disclosure to 500 of the 6,175 Medicare participating hospitals. The 500 hospitals selected are 290 that did not respond to our voluntary DRA survey, plus an additional 210 hospitals selected from across the country.

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Authorizing Statute(s): US Code: 42 USC 1395 Name of Law: Prohibition of Certain Referrals
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AF58	Final or interim final rulemaking	56 FR 61374	12/03/1991

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 28056	05/18/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 52568	09/14/2007
Did the Agency receive public comments on this ICR? Yes

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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
Title Disclosure of Financial Relationships Report ("DFRR") - CMS-10236

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Pursuant to Section 5006 of the Deficit Reduction Act of 2005, the Secretary was required to submit a Strategic and Implementing Plan to Congress concerning physician investment in specialty hospitals. In the August 8, 2006 Report to Congress, the Secretary stated that we would begin a regular financial disclosure process, pursuant to our authority at Section 1877(f) of the Social Security Act. The mandatory completion of the DFRR by 500 hospitals is the first step toward implementing a regular financial disclosure process that would apply to all Medicare participating hospitals.

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Annual Cost to Federal Government: $1,635,000

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: 09/27/2007

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