The Fiscal Soundness Reporting Requirements

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Summary-Response doc.docx	Supplementary Document	Uploaded 2010-04-27	Available
#1 National PACE Assoc.docx	Supplementary Document	Uploaded 2010-04-27	Available
Crosswalk_for_CMS_906.pdf	Supplementary Document	Uploaded 2010-03-19	Available
REV_Fiscal Soundness Reporting Req42210tc.doc	Supplementary Document	Uploaded 2010-04-27	Repair queued
2011 OMB 83-i Supporting Statement ja.doc	Supporting Statement A	Uploaded 2010-03-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8094	The Fiscal Soundness Reporting Requirements (CMS-906)	Other-screen shot	Modified

ICR Details

OMB Control No: 0938-0469	ICR Reference No: 201004-0938-001
Status: Historical Active	Previous ICR Reference No: 200806-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: The Fiscal Soundness Reporting Requirements
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/30/2010
	Date Received in OIRA: 04/05/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2013	36 Months From Approved	12/31/2011
Responses	1,039	0	700
Time Burden (Hours)	346	0	233
Cost Burden (Dollars)	0	0	0

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Abstract: The information in this collection will be used by the financial review team in order to establish that the MAOs, PDPs, PACE Organizations, 1876 Cost Plans and Demonstration Plans are maintaining fiscally sound organizations.

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Authorizing Statute(s): Statute at Large: 18 Stat. 1857 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:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 1060	01/08/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 13544	03/22/2010
Did the Agency receive public comments on this ICR? No

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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
The Fiscal Soundness Reporting Requirements (CMS-906)

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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	1,039	700	0	339	0	0
Annual Time Burden (Hours)	346	233	0	113	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: The reason for the change in this collection document is due to the June 2008 reorganization where the responsibility for monitoring financial condition of Part D sponsors was moved from the MDBG program to the MCAG program. It is noteworthy to say that all organizations required to report will undergo a slight decrease in burden due to having to submit 4 data elements instead of previously having to submit 13. However, due to the fact organizations reporting under Part D are now being added to this collection effort there is an increase in burden.

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Annual Cost to Federal Government: $25,142

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: 04/05/2010

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