Disclosure of Financial Relationships Report (DFRR)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10236 coverletter to 400 hospitals -12.08.doc	Supplementary Document	Uploaded 2008-12-16	Repair queued
CMS-10236 Summary of Changes to DFRR 12.08.doc	Supplementary Document	Uploaded 2008-12-16	Repair queued
CMS- Supporting Statement 12.08.doc	Supporting Statement A	Uploaded 2008-12-16	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
182211	Title Disclosure of Financial Relationships Report (DFRR) - (CMS-10236)	Instruction	Modified

ICR Details

OMB Control No:	ICR Reference No: 200901-0938-002
Status: Historical Inactive	Previous ICR Reference No: 200710-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Disclosure of Financial Relationships Report (DFRR)
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 06/14/2010
	Date Received in OIRA: 01/06/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 1877(f) of the Social Security Act requires that each entity providing covered services for which payment may be made shall provide the Secretary with the information concerning the entity's ownership, investment, and compensation arrangements. Section 5006 of the DRA requires us to consider the issue of annual disclosure of investment and compensation arrangements information. In the Final Report to Congress and Strategic & Implementing Plan required under this section, released August 2006, we stated that pursuant to 42 CFR ? 411.361 we would require all hospitals to provide us information on a periodic basis concerning their ownership, investment and compensation relationships with physicians. We are limiting our initial disclosure to 400 of the 6,163 Medicare participating hospitals.

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Authorizing Statute(s): Statute at Large: 18 Stat. 1877 Name of Statute: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AP15	Final or interim final rulemaking	73 FR 48437	08/19/2008

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 23700	04/30/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 77701	12/19/2008
Did the Agency receive public comments on this ICR? Yes

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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
Title Disclosure of Financial Relationships Report (DFRR) - (CMS-10236)	CMS-10236	Disclosure of Financial Relationships Report ("DFRR")

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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 5006 of the Deficit Reduction Act of 2005, the Secretary was required to submit a Strategic and Implementing Plan to Congress concerning physician investment in specialty hospitals. In the August 8, 2006 Report to Congress, the Secretary stated that we would begin a regular financial disclosure process for all hospitals, pursuant to our authority at Section 1877(f) of the Social Security Act. The mandatory completion of the DFRR by 400 hospitals will allow us to examine financial relationships between hospitals and physicians to determine whether they are compliant with the physician self referral statute and implementing regulations. In addition, the results from the DFRR may assist in other rulemaking efforts.

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Annual Cost to Federal Government: $1,650,000

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]? No

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)? No

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: 01/05/2009

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