Ambulatory Surgical Centers Conditions of Coverage

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10279 Supporting Statement Part A _ 508 compliant.pdf	Supporting Statement A	Uploaded 2013-09-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
189557	Ambulatory Surgical Centers Conditions of Coverage (416.50)(a)(3)		Modified
189556	Ambulatory Surgical Centers Conditions of Coverage (416.50)(a)(1)		Modified
189555	Ambulatory Surgical Centers Conditions of Coverage (416.43)		Modified
189554	Ambulatory Surgical Centers Conditions of Coverage (416.41)		Modified

ICR Details

OMB Control No: 0938-1071	ICR Reference No: 201309-0938-020
Status: Historical Active	Previous ICR Reference No: 200906-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No: 20480
Title: Ambulatory Surgical Centers Conditions of Coverage
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/21/2014
	Date Received in OIRA: 09/18/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2017	36 Months From Approved
Responses	21,200	0	0
Time Burden (Hours)	206,700	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The information collection requirements, as discussed in the supporting statement, are needed to implement the Medicare and Medicaid CfCs for 5,100 ambulatory surgical centers.

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Authorizing Statute(s): PL: Pub.L. 96 - 499 934 Name of Law: Outpatient Surgery
  

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:
	78 FR 32659	05/31/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 48686	08/09/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Ambulatory Surgical Centers Conditions of Coverage (416.41)
Ambulatory Surgical Centers Conditions of Coverage (416.43)
Ambulatory Surgical Centers Conditions of Coverage (416.50)(a)(1)
Ambulatory Surgical Centers Conditions of Coverage (416.50)(a)(3)

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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	21,200	0	0	800	0	20,400
Annual Time Burden (Hours)	206,700	0	0	7,800	0	198,900
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: Changes to the burden are a reflection of the increase in the number of Medicare certified ASCs at this time compmared to the previous collection and the changes in currenty average hourly rate fro medical professionals used in the calculations.

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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: 09/18/2013

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