Survey of Contract Labor in Selected Health Industries

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10177 CMS SURVEY OF HOSPITALS, SKILLED NURSING FACILITIES, AND KIDNEY DIALYSIS CENTERS	Form and Instruction	New	Available
Form CMS-10177 CMS SURVEY OF HOSPITALS, SKILLED NURSING FACILITIES, AND KIDNEY DIALYSIS CENTERS	Form and Instruction	New	Available
CMS-10177.Supporting Statement Part B-11-19-07.doc	Supporting Statement B	Uploaded 2008-01-03	Available
CMS-10177.Emergency Justification-FINAL.doc	Supplementary Document	Uploaded 2008-01-03	Available
CMS-10177.Supporting Statement Part A-11-19-07.doc	Supporting Statement A	Uploaded 2008-01-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
183298	Survey of Contract Labor in Selected Health Industries	Other-Survey Cover Letter	New
183298	Survey of Contract Labor in Selected Health Industries	Form and Instruction	New	CMS SURVEY OF HOSPITALS, SKILLED NURSING FACILITIES, AND KIDNEY DIALYSIS CENTERS
183297	Survey of Contract Labor in Selected Health Industries	Other-Survey Cover Letter	New
183297	Survey of Contract Labor in Selected Health Industries	Form and Instruction	New	CMS SURVEY OF HOSPITALS, SKILLED NURSING FACILITIES, AND KIDNEY DIALYSIS CENTERS

ICR Details

OMB Control No: 0938-1036	ICR Reference No: 200801-0938-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Survey of Contract Labor in Selected Health Industries
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 01/14/2008
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/22/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/08/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2008	6 Months From Approved
Responses	4,000	0	0
Time Burden (Hours)	4,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CMS will survey hospitals, skilled nursing facilities, and kidney dialysis centers to determine in their professional service contract labor is hired from local or national labor markets. Professional service contract labor includes accounting and auditing, engineering, legal, and management consulting services.

Emergency Justfication: See attached document.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 404 Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act of 2003
  

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
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 71140	12/14/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Survey of Contract Labor in Selected Health Industries	CMS-10177	CMS SURVEY OF HOSPITALS, SKILLED NURSING FACILITIES, AND KIDNEY DIALYSIS CENTERS
Survey of Contract Labor in Selected Health Industries	CMS-10177	CMS SURVEY OF HOSPITALS, SKILLED NURSING FACILITIES, AND KIDNEY DIALYSIS CENTERS

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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	4,000	0	0	4,000	0	0
Annual Time Burden (Hours)	4,000	0	0	4,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: CMS needs the information that will be collected in this survey to more accurately determine the shares of contract labor costs that are related to, influenced by, or vary with the local labor market and the share which represents purchases from contractors who are based nationally. Collection of this information via surveys of the hospital, SNF, and ESRD industries will enhance CMS's precision in making fair, equitable, and efficient payments to its PPS providers.

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Annual Cost to Federal Government: $0

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: 01/08/2008

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