Minimum Data Set (MDS) For Swing Bed Hospitals and Supporting Regulations in 42 CFR 483.20 and 413.337

Forms and Documents

Document Name	Status
Form CMS-10064 Minimum Data Set for Swing Bed Hospitals and Supporting Regulations in 42 0FR 413.114(a)(2) and 413.343(a) (CMS-10064) Form	New
AdditonalInformationSwingBedPRA08.doc Supplementary Document	2008-08-13
cleancopyCMS-10064Supporting Statement Revsied-03-31-08 (updated 05-14-08).doc Supporting Statement A	2008-08-13

IC Document Collections

IC ID	Document Title	Status
8693	Minimum Data Set for Swing Bed Hospitals and Supporting Regulations in 42 0FR 413.114(a)(2) and 413.343(a) (CMS-10064) Other-Manual	Modified
186455	Minimum Data Set for Swing Bed Hospitals and Supporting Regulations in 42 0FR 413.114(a)(2) and 413.343(a) (CMS-10064) Form	New

ICR Details

OMB Control No: 0938-0872	ICR Reference No: 200809-0938-009
Status: Historical Active	Previous ICR Reference No: 200510-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Minimum Data Set (MDS) For Swing Bed Hospitals and Supporting Regulations in 42 CFR 483.20 and 413.337
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: 12/12/2008
	Date Received in OIRA: 09/05/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	36 Months From Approved	12/31/2008
Responses	50,505	0	92,789
Time Burden (Hours)	328,283	0	51,314
Cost Burden (Dollars)	0	0	100,000

---

Abstract: As required under Section 1888(e)(7) of the Social Security Act, swing bed hospitals must be reimbursed under the skilled nursing facility prospective payment system. CMS uses the MDS data to reimburse swing bed hospitals for SNF-level care furnished to Medicare beneficiaries. The MDS 3.0 is currently being developed with an expectation of implementation in FY 2010. Since we do not have the MDS 3.0 version available, we are requesting an extension for the current SB-MDS.

---

Authorizing Statute(s): US Code: 42 USC 1395(yy)(e)(6) Name of Law: Submission of Resident Assessment Data
   PL: Pub.L. 105 - 1 188(e0(6) Name of Law: Submission of Resident Assessment Data
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AK47	Final or interim final rulemaking	66 FR 39600	07/31/2001

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 30105	05/23/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 46301	08/08/2008
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Minimum Data Set for Swing Bed Hospitals and Supporting Regulations in 42 0FR 413.114(a)(2) and 413.343(a) (CMS-10064)	CMS-10064	MINIMUM DATA SET (MDS) For Swing Bed Hospitals
Minimum Data Set for Swing Bed Hospitals and Supporting Regulations in 42 0FR 413.114(a)(2) and 413.343(a) (CMS-10064)	CMS-10064	MINIMUM DATA SET (MDS) For Swing Bed Hospitals

---

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	50,505	92,789	0	0	-42,284	0
Annual Time Burden (Hours)	328,283	51,314	0	0	276,969	0
Annual Cost Burden (Dollars)	0	100,000	0	0	-100,000	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:

---

Annual Cost to Federal Government: $250,000

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

---

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: 09/04/2008

---