CROWNWeb Authentication Service (CAS) Account Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10267 CROWNWeb Authentication Service (CAS) Account Form (2nd and 3rd Year)	Form and Instruction	Modified	Available
Form CMS-10267 CROWNWeb Authentication Service (CAS) Account Form (First Year)	Form and Instruction	Modified	Available
IDM_7[1].1.1._identity_info.BMP	Supplementary Document	Uploaded 2009-03-04	Available
IDM_7[1].1.1._qualiltynet.BMP	Supplementary Document	Uploaded 2009-03-04	Repair queued
IDM_7[1].1.1._business_info.BMP	Supplementary Document	Uploaded 2009-03-04	Available
IDM_7[1].1.1._basic_info.BMP	Supplementary Document	Uploaded 2009-03-04	Available
CMS-10267.Supporting Statement CAS - Part A (REVISED).doc	Supporting Statement A	Uploaded 2009-03-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
186127	CROWNWeb Authentication Service (CAS) Account Form (2nd and 3rd Year)	Form and Instruction	Modified
186126	CROWNWeb Authentication Service (CAS) Account Form (First Year)	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1050	ICR Reference No: 200903-0938-004
Status: Historical Active	Previous ICR Reference No: 200808-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: CROWNWeb Authentication Service (CAS) Account Form
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 with change	Conclusion Date: 05/08/2009
	Date Received in OIRA: 03/10/2009
Terms of Clearance: Per the PRA, the OMB control number must be printed/displayed on the paper and electronic information colletion instruments. CMS's request to forego displaying the expiration date on the paper instruments is approved consistent with the rationale provided in the supporting statement. However, it is not clear why the expiration date cannot be displayed on the electronic version of the instruments. Therefore, CMS shall either display the expiration date on the electronic forms or, on next submission, provide a compelling justification for why the expiration date cannot be displayed on the electronic form.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2011	36 Months From Approved	05/31/2009
Responses	15,600	0	15,600
Time Burden (Hours)	7,800	0	7,800
Cost Burden (Dollars)	0	0	0

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Abstract: The CROWNWeb Authentication Service (CAS) application must be completed by any person needing access to the CROWNWeb system which includes CMS employees, ESRD Network Organization staff and dialysis facilities staff. The CROWNWeb system is the system used as the collection point of data necessary for entitlement of ESRD patients to Medicare benefits and Federal Government monitoring and assessing of quality and type of care provided to renal patients. The data collected in CAS will provide the necessary security measures for creating and maintaining active CROWNWeb user accounts and collection of audit trail information required by the CMS Information Security Officers (ISSO).

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Authorizing Statute(s): None

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:
	73 FR 72486	11/28/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 8546	02/25/2009
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
CROWNWeb Authentication Service (CAS) Account Form (2nd and 3rd Year)	CMS-10267	CAS Account Form
CROWNWeb Authentication Service (CAS) Account Form (First Year)	CMS-10267	CAS Account Form

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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	15,600	15,600	0	0	0	0
Annual Time Burden (Hours)	7,800	7,800	0	0	0	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:

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Annual Cost to Federal Government: $324,000

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)? 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: 03/10/2009

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