New Freedom Initiative - Web-based Reporting System for Grantees (CMS-10161)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10161 Real Choice Systems Change Grants Web-Based Reporting System FFY 2005 Annual Report	Form and Instruction	Modified	Available
CMS-10161 - Supporting Statement part A [rev 10-09-2012 by OSORA PRA].doc	Supporting Statement A	Uploaded 2012-10-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8841	New Freedom Initiative - Web-based Reporting System for Grantees	Form and Instruction	Modified	Real Choice Systems Change Grants Web-Based Reporting System FFY 2005 Annual Report

ICR Details

OMB Control No: 0938-0979	ICR Reference No: 201210-0938-006
Status: Historical Active	Previous ICR Reference No: 200901-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: New Freedom Initiative - Web-based Reporting System for Grantees (CMS-10161)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/20/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/11/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	36 Months From Approved
Responses	428	0	0
Time Burden (Hours)	3,764	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CMS currently awards competitive grants to States and other eligible entities for the purpose of designing and implementing effective enduring improvements in community-based long-term services and support systems. CMS requires the information obtain through web-based grantee reporting for two reasons: (1) in order to effectively monitor the grants, and; (2) to report to Congress and other interested stakeholders the progress and obstacles experienced by grantees.

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Authorizing Statute(s): PL: Pub.L. 106 - 170 203 Name of Law: Grants to Develop and Establish State Infrastructures to Support Working Individuals
   EO: EO 13217 Name/Subject of EO: Community-based Alternatives for Inidivuals with Disabilities
  

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:
	77 FR 5258	02/02/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 59616	09/28/2012
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
New Freedom Initiative - Web-based Reporting System for Grantees	CMS-10161	Real Choice Systems Change Grants Web-Based Reporting System FFY 2005 Annual Report

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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	428	0	0	0	0	428
Annual Time Burden (Hours)	3,764	0	0	0	0	3,764
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: 10/11/2012

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