QIO Assumption of Responsibilities and Supporting Regulations

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-R-71 Final Supporting Statement.doc	Supporting Statement A	Uploaded 2013-11-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8057	QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 412.44		Modified
185531	QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.78(b)(3)		Modified
185530	QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.74(c)		Modified
185529	QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.74(b)		Modified
185528	QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.73(b)(2)		Modified
185527	QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.73(b)(1)		Modified
185526	QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.71 (FI Burden)		Removed
185525	QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.71		Modified
185524	QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 412.46		Modified
185523	QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 412.46 (QIO Burden)		Removed

ICR Details

OMB Control No: 0938-0445	ICR Reference No: 201311-0938-029
Status: Historical Active	Previous ICR Reference No: 200806-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No: 20985
Title: QIO Assumption of Responsibilities and Supporting Regulations
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: 02/12/2014
	Date Received in OIRA: 11/26/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2017	36 Months From Approved
Responses	56,377	0	0
Time Burden (Hours)	100,065	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Peer Review Improvement Act of 1982 amended Title XI of the Social Security Act to create the Utilization and Quality Control Peer Review Organization (PRO) program which replaces the Professional Standards Review Organization (PSRO) program and streamlines peer review activities. The term PRO has been renamed quality Improvement Organization (QIO). This collection describes the review functions to be performed by the QIO. It outlines relationships among QIOs, providers, practitioners, beneficiaries, intermediaries, and carriers.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 48687	08/09/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 65658	11/01/2013
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 412.44
QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 412.46
QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.71
QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.73(b)(1)
QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.73(b)(2)
QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.74(b)
QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 412.46 (QIO Burden)
QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.71 (FI Burden)
QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.74(c)
QIO Assumption of Responsibilities and Supp. Regs. in 42 CFR Sections 476.78(b)(3)

---

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	56,377	0	0	-69,851	0	126,228
Annual Time Burden (Hours)	100,065	0	0	-56,781	0	156,846
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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Changes in burden account for a decrease in the number of participating facilities and identified higher weighted DRG errors.

---

Annual Cost to Federal Government: $3,483,526

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

---

Common Form ICR:  No

---

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: 11/26/2013

---