Competitive Acquisition Program (CAP) for Medicare Part B Drugs: CAP Physician Election Agreement

Forms and Documents

Document	Type	Status	Availability
Form CMS-10167 Competitive Acquisition Program (CAP) for Medicare Part B Drugs: CAP Physician Election Agreement	Form and Instruction	Modified	Available
cap.osora.cms10167.FINAL.crosswalk.doc	Supplementary Document	Uploaded 2008-06-17	Repair queued
cap.osora.cms10167.FINAL.doc	Supporting Statement A	Uploaded 2008-06-17	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
8849	Competitive Acquisition Program (CAP) for Medicare Part B Drugs: CAP Physician Election Agreement	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0987	ICR Reference No: 200806-0938-008
Status: Historical Active	Previous ICR Reference No: 200602-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Competitive Acquisition Program (CAP) for Medicare Part B Drugs: CAP Physician Election Agreement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/05/2008
	Date Received in OIRA: 06/27/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	36 Months From Approved	04/30/2009
Responses	3,800	0	10,000
Time Burden (Hours)	7,600	0	20,000
Cost Burden (Dollars)	0	0	0

---

Abstract: The CAP Physician Election Agreement is used annually by physicians to elect to participate in the CAP or to make changes to the previous year's selections.

---

Authorizing Statute(s): PL: Pub.L. 108 - 173 303(d)(1) Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act of 2003
   PL: Pub.L. 109 - 432 108 Name of Law: MIEA-TRHCA 2006
   US Code: 42 USC 1392w-3b Name of Law: Competitive acquisition of outpatient drugs and biologicals
   Statute at Large: 18 Stat. 1847 Name of Statute: null
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AO65	Final or interim final rulemaking	72 FR 66260	11/27/2007

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 17347	04/01/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 33824	06/13/2008
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Competitive Acquisition Program (CAP) for Medicare Part B Drugs: CAP Physician Election Agreement	CMS-10167	Competitive Acquistion Program (CAP) for Medicare Part B Drugs Cap Physician Election Agreement (Under Section 1847B of the Social Security Act)

---

ICR Summary 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	3,800	10,000	0	0	-6,200	0
Annual Time Burden (Hours)	7,600	20,000	0	0	-12,400	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: The estimated annual number of hours needed to complete this application is 7600 hours for 3800 physicians, as compared to our previous estimates of 20,000 hours for 10,000 physicians. This program adjustment change was based on experience garnered through CAP operations.

---

Annual Cost to Federal Government: $0

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

---

Common Form ICR:  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:

(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: 06/27/2008

---