Administrative Requirements for Section 6071 of the Deficit Reduction Act of 2005 (CMS-10249)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10249 6352 MFP Questionnaire	Form	New	Available
Form CMS-10249 Medical Assistance Expenditures by Type of Service	Form and Instruction	New	Available
Form CMS-10249 MFP Demonstration Financial Form	Form and Instruction	New	Available
Form CMS-10249 Budget Form	Form and Instruction	New	Available
Form CMS-10249 Operational Protocol	Form and Instruction	New	Available
CMS-10249 Supporting Statement.doc	Supporting Statement A	Uploaded 2008-09-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
186838	Administrative Requirements for Section 6071 of the DRA (CMS-10249)	Form	New	6352 MFP Questionnaire
186838	Administrative Requirements for Section 6071 of the DRA (CMS-10249)	Form and Instruction	New	Medical Assistance Expenditures by Type of Service
186838	Administrative Requirements for Section 6071 of the DRA (CMS-10249)	Form and Instruction	New	MFP Demonstration Financial Form
186838	Administrative Requirements for Section 6071 of the DRA (CMS-10249)	Form and Instruction	New	Budget Form
186838	Administrative Requirements for Section 6071 of the DRA (CMS-10249)	Form and Instruction	New	Operational Protocol
186838	Administrative Requirements for Section 6071 of the DRA (CMS-10249)	Other-Draft Proposed Content for MFP Services File	New

ICR Details

OMB Control No: 0938-1053	ICR Reference No: 200810-0938-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Administrative Requirements for Section 6071 of the Deficit Reduction Act of 2005 (CMS-10249)
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: Approved without change	Conclusion Date: 12/19/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/07/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	36 Months From Approved
Responses	304	0	0
Time Burden (Hours)	10,394	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Medicare & Medicaid Services (CMS) awarded 31 grants to States to participate in the Money Follows the Person Rebalancing Demonstration (MFP) from January 1, 2007 through September 30, 2011. This demonstration, created by section 6071 of the Deficit Reduction Act of 2005 (P.L. 109-171), supports State efforts to "rebalance" their long-term support systems by offering $1.75 billion over 5 years in competitive grants to States. Specifically, the demonstration will support State efforts to: a) Rebalance their long-term support system so that individuals have a choice of where they live and receive services; b) Transition individuals from institutions who want to live in the community; and c) Promote a strategic approach to implement a system that provides person centered, appropriate, needs based, quality of care and quality of life services and a quality management strategy that ensures the provision of, and improvement of such services in both home and community-based settings and institutions. The demonstration provides enhanced federal medical assistance percentage (FMAP) for 12 months for qualified home and community-based services for each person transitioned from an institution to the community during the demonstration period.

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Authorizing Statute(s): PL: Pub.L. 109 - 171 6071 Name of Law: Money Follows the Person
  

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
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 50372	08/31/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 49677	08/22/2008
Did the Agency receive public comments on this ICR? No

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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
Administrative Requirements for Section 6071 of the DRA (CMS-10249)	CMS-10249, CMS-10249, CMS-10249, CMS-10249, CMS-10249	Operational Protocol ,   Budget Form ,   MFP Demonstration Financial Form ,   Medical Assistance Expenditures by Type of Service ,   6352 MFP Questionnaire

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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	304	0	0	304	0	0
Annual Time Burden (Hours)	10,394	0	0	10,394	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Under section 6071 of the Deficit Reduction Act of 2005 (P.L. 109-171) subsection (c), the Secretary may require States to meet requirements and provide additional information, provisions, and assurances. Through the Operational Protocol, States provide the requirements, information, provisions and assurances which, following CMS approval, States may enroll individuals in the State's demonstration program or begin to claim for service dollars.

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Annual Cost to Federal Government: $32,075

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: 10/07/2008

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