Issuance of Advisory Opinions Concerning Physicians' Referrals (CMS-R-216)

Forms and Documents

Document Name	Status
CMS-R-216 AO Supporting Statement 7-23-10.DOC Supporting Statement A	2010-12-30

IC Document Collections

IC ID	Document Title	Status
8365	Procedures for advisory opinions concerning physician referrals (CMS-R-216)	Modified

ICR Details

OMB Control No: 0938-0714	ICR Reference No: 201101-0938-008
Status: Historical Active	Previous ICR Reference No: 200709-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Issuance of Advisory Opinions Concerning Physicians' Referrals (CMS-R-216)
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 without change	Conclusion Date: 03/21/2011
	Date Received in OIRA: 01/25/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2014	36 Months From Approved	03/31/2011
Responses	25	0	50
Time Burden (Hours)	500	0	1,000
Cost Burden (Dollars)	0	0	0

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Abstract: Section 1877(g)(6) of the Social Security Act requires that the Department of Health and Human Services issue advisory opinions concerning whether the referral of a Medicare patient by a physician for designated health services" (other than clinical laboratory services) is prohibited under the physician referral provisions of the Social Security Act. The Centers for Medicare & Medicaid Services promulgated 42 CFR 411.370 through 411.389 to comply with this statutory mandate. The collection of information contained in 42 CFR 411.372 and 411.373 is necessary to allow CMS to consider requests for advisory opinions and provide accurate and useful opinions.

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Authorizing Statute(s): US Code: 42 USC 1395 Name of Law: LIMITATION ON CERTAIN PHYSICIAN REFERRALS
  

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 51462	08/20/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 69445	11/12/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Procedures for advisory opinions concerning physician referrals (CMS-R-216)

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ICR Summary 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	25	50	0	0	-25	0
Annual Time Burden (Hours)	500	1,000	0	0	-500	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: $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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 01/25/2011

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