Consumer Research on Public Reporting of Hospital Outpatient Measures (CMS-10310)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10310 Attachment C1 - Cogntive Interview Guide Consumers Caregivers	Form and Instruction	New	Available
Form CMS-10310 Attachment C2 - Cogntive Interview Guide Professionals	Form and Instruction	New	Available
Form CMS-10310 Attachment B3_Screening Form_Professionals_REV	Form and Instruction	New	Available
Form CMS-10310 Attachment B1_Screening Form_Consumers	Form and Instruction	New	Available
Form CMS-10310 Attachment B2_Screening Form_Caregivers	Form and Instruction	New	Available
Hospital Outpatient Measures_Formative Research_Summary Findings Memo_REV.doc	Supplementary Document	Uploaded 2010-01-25	Available
CMS-10310.Outpatient Measures_Informed Consent.doc	Supplementary Document	Uploaded 2010-01-25	Available
CMS-10310.Mockup 4_Imaging Measures_REV_1_15.doc	Supplementary Document	Uploaded 2010-01-25	Available
CMS-10310.Mockup 3_HA Measures_REV_1_15_v2.doc	Supplementary Document	Uploaded 2010-01-25	Available
CMS-10310.Mockup 1_Outpatient Measures Pathway_REV_1_15.doc	Supplementary Document	Uploaded 2010-01-25	Available
CMS-10310.Outpatient_Inpatient Definitions.doc	Supplementary Document	Uploaded 2010-01-25	Available
CMS-10310.Mockup 2_Surgery Measures_REV_1_15_v2.docx	Supplementary Document	Uploaded 2010-01-25	Available
CMS-10310 Supporting Statement Part A - CLEAN-2-3-10.docx	Supporting Statement A	Uploaded 2010-02-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
191851	(CMS-10310) - Patient and Caregiver Interviews	Form and Instruction	New	Attachment C1 - Cogntive Interview Guide Consumers Caregivers
191850	(CMS-10310) - PCP, Specialist and Tech Interviews	Form and Instruction	New	Attachment C2 - Cogntive Interview Guide Professionals
191849	(CMS-10310) - Initial Screening	Form and Instruction	New	Attachment B3_Screening Form_Professionals_REV
191849	(CMS-10310) - Initial Screening	Form and Instruction	New	Attachment B1_Screening Form_Consumers
191849	(CMS-10310) - Initial Screening	Form and Instruction	New	Attachment B2_Screening Form_Caregivers

ICR Details

OMB Control No: 0938-1081	ICR Reference No: 201001-0938-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Consumer Research on Public Reporting of Hospital Outpatient Measures (CMS-10310)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 01/26/2010
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/05/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/25/2010
Terms of Clearance: This ICR is approved consistent with revised supporting statement and instruments. CMS agrees to share a copy of the results before the HOPQDRP data is publicly reported on HospitalCompare.gov.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2010	6 Months From Approved
Responses	104	0	0
Time Burden (Hours)	41	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CMS plans to publicly report a set of hospital outpatient measures on Hospital Compare in June 2010. This qualitative research is to test options for displaying and explaining the measures, so that what is posted can be readily understood and used by average consumers and patients.

Emergency Justfication: As agreed upon during a conference call with OMB on December 2, 2009, CMS is submitting this ICR for emergency review and processing. OMB has already informally reviewed the ICR. We are formally submitting the files for approval.

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Authorizing Statute(s): PL: Pub.L. 109 - 432 109(a) Name of Law: Quality reporting for hospital outpatient services and ambulatory surgical center services.
   US Code: 42 USC 1395l(t)(17) Name of Law: Prospective payment system for hospital outpatient department services
  

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:
	75 FR 370	01/05/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 370	01/05/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
(CMS-10310) - Initial Screening	CMS-10310, CMS-10310, CMS-10310	Attachment B2_Screening Form_Caregivers ,   Attachment B1_Screening Form_Consumers ,   Attachment B3_Screening Form_Professionals_REV
(CMS-10310) - PCP, Specialist and Tech Interviews	CMS-10310	Attachment C2 - Cogntive Interview Guide Professionals
(CMS-10310) - Patient and Caregiver Interviews	CMS-10310	Attachment C1 - Cogntive Interview Guide Consumers Caregivers

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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	104	0	0	104	0	0
Annual Time Burden (Hours)	41	0	0	41	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: This is a new information collection request.

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Annual Cost to Federal Government: $68,000

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: 01/25/2010

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