Program Evaluation of the Ninth Scope of Work Quality Improvement Organization Program (CMS-10294)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10294 Discussions with QIO Partner Organizations (No Full Discussion)	Form and Instruction	New	Available
Form CMS-10294 Discussions with QIO Partner Organizations (Full Discussions)	Form and Instruction	New	Available
Form CMS-10294 Case Study Discussions	Form and Instruction	New	Available
Form CMS-10294 Nursing Home survey	Form and Instruction	New	Available
Form CMS-10294 QIO Survey - Theme Leader Survey	Form and Instruction	New	Available
Form CMS-10294 QIO Survey - QIO director	Form and Instruction	New	Available
Form CMS-10294 Hospital Survey	Form and Instruction	New	Available
Form CMS-10294 Focus Groups	Form and Instruction	New	Available
CMS-10294.Appendix G (8-23-10).pdf	Supplementary Document	Uploaded 2010-08-27	Available
CMS-10294.Appendix F (8-23-10).pdf	Supplementary Document	Uploaded 2010-08-27	Available
CMS-10294.Appendix E (8-23-10).pdf	Supplementary Document	Uploaded 2010-08-27	Available
CMS-10294.Appendix D (8-23-10).pdf	Supplementary Document	Uploaded 2010-08-27	Available
CMS-10294.Appendix C (8-23-10).pdf	Supplementary Document	Uploaded 2010-08-27	Available
CMS-10294.Appendix B (8-23-10).pdf	Supplementary Document	Uploaded 2010-08-27	Available
CMS-10294.Appendix A (8-23-10).pdf	Supplementary Document	Uploaded 2010-08-27	Available
Math_PRA_OMB discussion 100707.docx	Supplementary Document	Uploaded 2010-07-08	Available
Rollow et al annals.pdf	Supplementary Document	Uploaded 2010-07-08	Available
Jencks_q2000.pdf	Supplementary Document	Uploaded 2010-07-08	Available
Jencks_q2003.pdf	Supplementary Document	Uploaded 2010-07-08	Available
MPR 8th SOW draft rpt.pdf	Supplementary Document	Uploaded 2010-07-08	Available
NORC Final QIO Report 1.29.07.pdf	Supplementary Document	Uploaded 2010-07-08	Available
REV-DESIGN REPORT.pdf	Supplementary Document	Uploaded 2010-07-08	Available
CMS-10294.Supporting Statment Part B (8-23-10).pdf	Supporting Statement B	Uploaded 2010-08-27	Available
CMS-10294.Appendices.pdf	Supplementary Document	Uploaded 2010-03-18	Available
CMS-10294.Supporting Statment Part A (8-23-10).pdf	Supporting Statement A	Uploaded 2010-08-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192517	Discussions with QIO Partner Organizations (No Full Discussion)	Form and Instruction	New
192516	Discussions with QIO Partner Organizations (Full Discussions)	Form and Instruction	New
192515	Case Study Discussions	Form and Instruction	New
192514	Nursing Home survey	Form and Instruction	New
192513	QIO Survey - Theme Leader Survey	Form and Instruction	New
192512	QIO Survey - QIO director	Form and Instruction	New
192511	Hospital Survey	Form and Instruction	New
192510	Focus Groups	Form and Instruction	New

ICR Details

OMB Control No: 0938-1104	ICR Reference No: 201004-0938-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Program Evaluation of the Ninth Scope of Work Quality Improvement Organization Program (CMS-10294)
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: Approved with change	Conclusion Date: 09/01/2010
	Date Received in OIRA: 04/12/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2013	36 Months From Approved
Responses	3,495	0	0
Time Burden (Hours)	1,851	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the study is to design and conduct an analysis evaluating the impact on national and regional health care processes and outcomes of the Ninth Scope of Work QIO Program. The QIO Program is national in scope and scale and affects the quality of healthcare of 43 million elderly and disabled Americans. CMS will conduct an impact and process analysis using data from multiple sources: (1) primary data collected via in-depth interviews, and surveys of QIOs, health care providers, and other stakeholders; (2) secondary data reported by QIOs through CMS systems; and (3) CMS administrative data. The findings will be presented in a final report as well as in other documents and reports suitable for publication in peer-review journals. This request relates to the following data collections: (1) Survey of QIO directors and theme leaders; (2) Survey of hospital QI directors and nursing home administrators; and (3)in-person and telephone discussions with QIO staff, partner organizations, health care providers, and community health leaders.

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Authorizing Statute(s): US Code: 42 USC 1395y Name of Law: Exclusions from coverage and medicare as secondary payer
   US Code: 42 USC 1320c-3 Name of Law: Functions of peer review organizations
  

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 52236	10/06/2009
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: 8

table that charts list of burden

IC Title	Form No.	Form Name
Discussions with QIO Partner Organizations (No Full Discussion)	CMS-10294	CMS-10294.QIO Surveys and Letters
Focus Groups	CMS-10294	CMS-10294.QIO Surveys and Letters
Hospital Survey	CMS-10294	CMS-10294.QIO Surveys and Letters
QIO Survey - QIO director	CMS-10294	CMS-10294.QIO Surveys and Letters
QIO Survey - Theme Leader Survey	CMS-10294	CMS-10294.QIO Surveys and Letters
Nursing Home survey	CMS-10294	CMS-10294.QIO Surveys and Letters
Case Study Discussions	CMS-10294	CMS-10294.QIO Surveys and Letters
Discussions with QIO Partner Organizations (Full Discussions)	CMS-10294	CMS-10294.QIO Surveys and Letters

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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	3,495	0	0	3,495	0	0
Annual Time Burden (Hours)	1,851	0	0	1,851	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: $948,014

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 04/12/2010

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