Data collection for Medicare Beneficiaries Receiving FDG Positron Emission Tomography (PET) for Brain, Cervical, Ovarian, Pancreatic, Small Cell Lung, and All Other Cancers

ICR 200811-0938-006

OMB: 0938-0968

Federal Form Document

ICR Details
0938-0968 200811-0938-006
Historical Active 200508-0938-005
HHS/CMS
Data collection for Medicare Beneficiaries Receiving FDG Positron Emission Tomography (PET) for Brain, Cervical, Ovarian, Pancreatic, Small Cell Lung, and All Other Cancers
Extension without change of a currently approved collection   No
Regular
Approved with change 05/11/2009
Retrieve Notice of Action (NOA) 11/25/2008
  Inventory as of this Action Requested Previously Approved
05/31/2012 36 Months From Approved 05/31/2009
50,000 0 50,000
4,167 0 4,167
0 0 0

To qualify for payment, providers must prescribe FDG PETs for beneficiaries with a set of clinical criteria specific to each cancer type and stage. CMS is requiring stakeholders including specialty societies, industry, health plans and hospital associations to create systematic clinical data bases or registries to be reimbursed for FDG PETs for beneficiaries. Data elements collected electronically on the associated instrument will be transmitted to CMS for evaluation of the short and long term benefits of FDG PETs to beneficiaries and for use in future clinical decision making.

None
None

Not associated with rulemaking

  73 FR 51820 09/05/2008
73 FR 67520 11/14/2008
Yes

  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 50,000 50,000 0 0 0 0
Annual Time Burden (Hours) 4,167 4,167 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
No
Uncollected
William Parham 4107864669

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/25/2008


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