Conditions of Participation for Community Mental Health Centers and Supporting Regulations (CMS-10506)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10506_Supporting_Statement_Part_A.docx	Supporting Statement A	Uploaded 2014-03-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210877	42 CFR 485.918(b)(1)(v) Organization, governance, administration of services and partial hospitalization		New
210876	42 CFR 485.917 Quality assessment and performance improvement.		New
210875	42 CFR 485.916(d) Treatment team, active treatment plan, and coordination of services		New
210874	42 CFR 485.916(c) Treatment team, active treatment plan, and coordination of services		New
210873	42 CFR 485.910(f)(4) Client Rights		New
210872	42 CFR 485.910(e)(4)(v) Client Rights		New
210871	42 CFR 485.910(d)(4) Client Rights		New
210870	42 CFR 485.910(d)(2) Client Rights		New
210869	42 CFR 485.910(a)(3) - Client Rights		New
210868	42 CFR 485.910(a)(1) - Client Rights		New

ICR Details

OMB Control No: 0938-1245	ICR Reference No: 201403-0938-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 21616
Title: Conditions of Participation for Community Mental Health Centers and Supporting Regulations (CMS-10506)
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: Approved without change	Conclusion Date: 07/03/2014
	Date Received in OIRA: 03/21/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved
Responses	78,930	0	0
Time Burden (Hours)	8,972	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The information collection requirements contained in this information collection request are among other requirements classified as (or known as) the CoPs which are based on criteria prescribed in law and are standards designed to ensure that each facility has properly trained staff to provide the appropriate safe physical environment for patients. These particular standards reflect comparable standards developed by industry organizations such as the Joint Commission. The primary users of this information will be State agency surveyors, CMS and community mental health centers (CMHCs )for the purpose of ensuring compliance with Medicare CoPs as well as ensuring the quality of care provided by CMHCs to patients.

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Authorizing Statute(s): PL: Pub.L. 101 - 508 4162 Name of Law: Omnibus Budget Reconciliation Act of 1990
   US Code: 42 USC 1395k Name of Law: Scope of benefits; definitions
   US Code: 42 USC 1395x(ff)(3) Name of Law: Health Insurance for Aged and Disabled
  

Citations for New Statutory Requirements: PL: Pub.L. 101 - 508 4162 Name of Law: Omnibus Budget Reconciliation Act of 1990
US Code: 42 USC 1395k Name of Law: SCOPE OF BENEFITS
US Code: 42 USC 1395x(ff)(3) Name of Law: Health Insurance for Aged and Disabled

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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 64604	10/29/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 13305	03/10/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
42 CFR 485.910(a)(1) - Client Rights
42 CFR 485.910(a)(3) - Client Rights
42 CFR 485.910(d)(2) Client Rights
42 CFR 485.910(d)(4) Client Rights
42 CFR 485.910(e)(4)(v) Client Rights
42 CFR 485.910(f)(4) Client Rights
42 CFR 485.916(c) Treatment team, active treatment plan, and coordination of services
42 CFR 485.916(d) Treatment team, active treatment plan, and coordination of services
42 CFR 485.917 Quality assessment and performance improvement.
42 CFR 485.918(b)(1)(v) Organization, governance, administration of services and partial hospitalization

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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	78,930	0	78,930	0	0	0
Annual Time Burden (Hours)	8,972	0	8,972	0	0	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: This is a new information collection request.

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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: 03/21/2014

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