Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64

Forms and Documents

Document Name	Status
Form CMS-10079 Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64 Form and Instruction	Modified
CMS-10079_Supporting_Statement_A - IPPS- Passback3.docx Supporting Statement A	2016-09-21

IC Document Collections

IC ID	Document Title	Status
8747	Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64 Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0907	ICR Reference No: 201512-0938-011
Status: Historical Active	Previous ICR Reference No: 201302-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: 18998
Title: Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64
Type of Information Collection: Extension without change 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: 12/28/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2019	36 Months From Approved	09/30/2016
Responses	3,400	0	3,500
Time Burden (Hours)	1,632,000	0	1,680,000
Cost Burden (Dollars)	0	0	0

---

Abstract: Section 304 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 requires CMS to collect wage data on hospital employees by occupational category, at least once every 3 years, in order to construct an occupational mix adjustment to the wage index. CMS first collected occupational mix data in 2003 for the FY 2005 wage index and a subsequent collection of occupational mix data was performed in 2006 for the FY 2007 and FY 2008 wage index. In response to industry comments suggesting ways to improve the occupational mix survey, CMS has revised the 2007/2008 survey that was used to calculate the FY 2010 wage index. We are revising the 2007/2008 survey to collect for a 12- month period (that is, from pay periods ending between January 1, 2010 and December 31, 2010). The revised occupational mix survey will be used to adjust the FY 2013 wage index.

---

Authorizing Statute(s): PL: Pub.L. 106 - 554 304 Name of Law: BIPA
   US Code: 18 USC 1886(d)(3)(E) Name of Law: Payments to inpatient hospitals for services.
  

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:
	80 FR 61212	10/09/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 80771	12/28/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64	CMS-10079	Medicare Wage Index Occupational Mix Survey

---

ICR Summary 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	3,400	3,500	0	0	-100	0
Annual Time Burden (Hours)	1,632,000	1,680,000	0	0	-48,000	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: The burden per response remains unchanged; however, the number of respondents decreased from 3,500 to 3,400. We have adjusted the estimated annual burden accordingly, which resulted in a decrease of 48,000 hours.

---

Annual Cost to Federal Government: $734,000

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: 12/28/2015

---