PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10431 PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	Available
PQ 2016-09-26 CMS-10431_Supporting Statement A - Passback.docx	Supporting Statement A	Uploaded 2016-09-26	Available
PCHQR PRA_Appendix A 04_07_2015 revised (508 ready ef).docx	Supplementary Document	Uploaded 2015-05-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1175	ICR Reference No: 201510-0938-001
Status: Historical Active	Previous ICR Reference No: 201505-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: 21324
Title: PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program
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: 09/27/2016
	Date Received in OIRA: 10/07/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2019	12/31/2017	11/30/2016
Responses	400,631	0	413,556
Time Burden (Hours)	200,425	0	206,891
Cost Burden (Dollars)	0	0	0

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Abstract: Section 3005 of the Affordable Care Act authorizes the establishment of a quality reporting program for PPS-exempt cancer hospitals (PCHs). This is an update to the previously approved PCHQR Program PRA submission. Based on the FY2016 IPPS/LTCH rule we are removing the six Surgical Care Improvement Program (SCIP) measures and adding three CDC NHSN measures.

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Authorizing Statute(s): PL: Pub.L. 111 - 48 3005 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS41	Final or interim final rulemaking	80 FR 49325	08/17/2015

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Federal Register Notices & Comments

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
PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431	Oncology Care Measures Paper Submission ,   SCIP Measures Paper Submission ,   EBRT Pop Sample Application ,   EBRT Paper based ,   EBRT Pop Sample paper based ,   EBRT web application ,   Oncology Care Measures Pop Sample application ,   OCM Pop Sample paper based ,   SCIP Pop Sample paper based ,   SCIP Pop Sample Application ,   Measure Exception Form

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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	400,631	413,556	0	-12,925	0	0
Annual Time Burden (Hours)	200,425	206,891	0	-6,466	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The burden decreased becasue six surgical care improvement project (SCIP) measures were removed. The total change in burden based on the changes in this year's rule are to decrease responses by 12,925 responses per year, which equates to a decrease of 6466 hours per year.

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Annual Cost to Federal Government: $20,800

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]? Yes

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: 10/07/2015

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