Conditions of Participation for Critical Access Hospitals and Supporting Regulations

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10239 Supporting Statement Part A (8-14-14 Response to OMB ).doc	Supplementary Document	Uploaded 2014-08-19	Available
Response to Public Comments.docx	Supplementary Document	Uploaded 2014-03-24	Available
CMS-10239 Final Supporting Statement Part A (8-19-14 ).doc	Supporting Statement A	Uploaded 2014-08-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
195096	42CFR485.635(f)		Modified
183848	42CFR485.645(d)		Modified
183847	42CFR485.643(a-b)		Modified
183846	42CFR485.641		Modified
183845	42CFR485.635(c)(3)		Modified
183844	42CFR485.631		Modified
183843	42CFR485.618		Modified
183842	42CFR485.623(d)(4)		Modified

ICR Details

OMB Control No: 0938-1043	ICR Reference No: 201403-0938-015
Status: Historical Active	Previous ICR Reference No: 201011-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: 21626
Title: Conditions of Participation for Critical Access Hospitals and Supporting Regulations
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/26/2014
	Date Received in OIRA: 03/28/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2017	36 Months From Approved	08/31/2014
Responses	150,493	0	143,994
Time Burden (Hours)	24,443	0	23,615
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection package is a revision of the approved information collection requirements. With this submission, we have updated our estimates to reflect the current number of facilities and the current BLS salary information. The information collection requirements, as discussed in the attached supporting statement, are needed to implement the Medicare CoPs for 1,233 CAHs.

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Authorizing Statute(s): US Code: 42 USC 1395hh Name of Law: Regulations
   US Code: 42 USC 1395aa Name of Law: Use of State Agencies to determine compliance by providers of services with CoPs
   US Code: 42 USC 1395x(e) and (mm) Name of Law: Part E - Miscellaneous Provisions
   US Code: 42 USC 1395(a)(8) Name of Law: Conditions of and Limitations on Payment for Services
   US Code: 42 USC 1320b-8 Name of Law: Hospital Protocols for Organ Procurement and Standards for Organ Procurement Agencies
   US Code: 42 USC 1302 Name of Law: Rules and Regulations
   US Code: 42 USC 1395i-4(a-f) Name of Law: Medicare Rural Hospital Flexibility Program
  

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 77135	12/20/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 14711	03/17/2014
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

IC Title	Form No.	Form Name
42CFR485.623(d)(4)
42CFR485.618
42CFR485.631
42CFR485.635(c)(3)
42CFR485.641
42CFR485.643(a-b)
42CFR485.645(d)
42CFR485.635(f)

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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	150,493	143,994	0	6,499	0	0
Annual Time Burden (Hours)	24,443	23,615	0	828	0	0
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: This package has been updated to reflect the current number of facilities and the current BLS salary information.

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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: 03/28/2014

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