Physician Certifications/Recertifications in Skilled Nursing Facilities Manual Instructions and Supporting Regs.

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
public comment_response-Physican cert_recert.doc	Supplementary Document	Uploaded 2009-07-09	Available
CLN Supporting Statement - Part A (2009)--corrected091709.doc	Supporting Statement A	Uploaded 2009-09-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43658	Physician Certifications/Recertifications in Skilled Nursing Facilities Manual Instructions and Supporting Regs.		Modified
190006	Physician Certifications/Recertifications in Skilled Nursing Facilities Manual Instructions and Supporting Regs.(CMS-R-5		New

ICR Details

OMB Control No: 0938-0454	ICR Reference No: 200907-0938-001
Status: Historical Active	Previous ICR Reference No: 200606-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Physician Certifications/Recertifications in Skilled Nursing Facilities Manual Instructions and Supporting Regs.
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: 10/13/2009
	Date Received in OIRA: 07/21/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2012	36 Months From Approved	10/31/2009
Responses	2,566,528	0	981,642
Time Burden (Hours)	585,466	0	547,578
Cost Burden (Dollars)	0	0	0

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Abstract: Regulations at 42 CFR 424.20 require SNFs to keep record of physician certifications and recertifications of information such as the need for care and services, estimated duration of the SNF stay, and plan for home care.

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Authorizing Statute(s): PL: Pub.L. 101 - 239 1814(a)(2) Name of Law: Requirement of Requests and Certifications
  

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:
	74 FR 11958	03/20/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 31737	07/02/2009
Did the Agency receive public comments on this ICR? Yes

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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
Physician Certifications/Recertifications in Skilled Nursing Facilities Manual Instructions and Supporting Regs.
Physician Certifications/Recertifications in Skilled Nursing Facilities Manual Instructions and Supporting Regs.(CMS-R-5

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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	2,566,528	981,642	0	-2,601,465	4,186,351	0
Annual Time Burden (Hours)	585,466	547,578	0	-75,799	113,687	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The change in burden is due to an increase in number of responses. In past collections, the estimated annual number of responses counted for persons with a certification only. In other words, persons who had a stay of 0 to 13 days were represented. This collection includes the number of responses for certifications and recertifications.

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Annual Cost to Federal Government: $0

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: 07/21/2009

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