Survey and Certification Training Staff Training Needs Assessment, Evaluation/Survey - Question Compilation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10374 Training Staff Training Needs Assessment, Evaluation/Survey - Question Compilation	Form and Instruction	New	Repair queued
CMS-10374 - Supporting Statement part A [rev 10-07-11].doc	Supporting Statement A	Uploaded 2011-10-07	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
199736	Training Staff Training Needs Assessment, Evaluation/Survey - Question Compilation	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 201110-0938-006
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Survey and Certification Training Staff Training Needs Assessment, Evaluation/Survey - Question Compilation
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: Improperly submitted	Conclusion Date: 11/10/2011
	Date Received in OIRA: 10/12/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CMS needs this information to create and enhance training for Health Care Surveyor inspector and Certification Specialists. These surveys will gather information for training needs assessment, training analysis, related demographic, psychographics and technographics to support the development and refinement of training and training aids. The primary target population is composed of Federal and State Health Care Surveyors and Certification Specialists. Additionally, State Training Coordinators, Regional Training Administrators and State IT directors may be impacted with requests for information. Surveyors are required by statute to conduct surveys and to be trained on how to perform provider surveys, (inspections and certification) functions needed to assure the quality of care of vulnerable CMS beneficiaries. These surveyors are specialized into the following areas: Long Term Care, Hospitals, Life Safety Code, End Stage Renal, Ambulatory Surgical Centers, Hospice, Intermediate Care Facility for Mentally Retarded, Laboratory Services, and Psychiatric. There are also Certification Specialists. The majority of this population work in State agencies and a smaller proportion work for the ten Federal Regional Offices. There are approximately 7400 such persons nationally. CMSC Training Staff provides training for approximately 2400 in traditional classroom setting and another 11,000 using distance-learning tools. The requested collection of information helps us track how our students see the value of our training and to help with needs assessment, training analysis and techno-graphics for new training development.

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Authorizing Statute(s): US Code: 42 USC 1396 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: US Code: 42 USC 1396 Name of Law: Social Security Act

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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:
	76 FR 41799	07/15/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 60843	09/30/2011
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
Training Staff Training Needs Assessment, Evaluation/Survey - Question Compilation	CMS-10374	Training Staff Training Needs Assessment, Evaluation/Survey - Question Compilation

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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: This is a new collection.

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Annual Cost to Federal Government: $4,440

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: 10/12/2011

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