Medicare Rural Hospital Flexibility Grant Program Performance Measures

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Medicare Rural Hospital Flexibility Grant Program Performance Measures	Form and Instruction	Modified	Available
Attachment B Flex 60 Day FRN Comments July 2015.pdf	Supplementary Document	Uploaded 2016-03-03	Available
Attachment A Flex FRN 60Day 2015-12700.pdf	Supplementary Document	Uploaded 2016-03-03	Available
Flex All Measures FY2010-2014 and removed.xlsx	Supplementary Document	Uploaded 2016-03-03	Available
Supporting Statement A Instructions Flex_OMB 0915-0363 Revision_KC229.docx	Supporting Statement A	Uploaded 2016-03-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206758	Medicare Rural Hospital Flexibility Grant Program Performance Measures	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0363	ICR Reference No: 201603-0915-001
Status: Historical Active	Previous ICR Reference No: 201305-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No: 19326
Title: Medicare Rural Hospital Flexibility Grant Program Performance Measures
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/09/2016
	Date Received in OIRA: 03/03/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2019	36 Months From Approved	07/31/2016
Responses	45	0	45
Time Burden (Hours)	3,150	0	9,720
Cost Burden (Dollars)	0	0	0

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Abstract: The Flex program supports state designated entities that assist critical access hospitals (CAHs) improve across Flex initiatives. These initiatives are meant to ensure residents in rural communities have access to high quality health care services. These initiatives cover the following principal topic areas: quality reporting and improvement; financial and operational improvement; population health management; Emergency Medical Service (EMS) Integration; critical access hospital (CAH) conversion; and Integration of Innovative Care Models. Flex program performance measures were drafted, and approved with stakeholder feedback to aggregate program data required by Congress under the Government Performance and Results Act (GPRA) of 2010. Such data is also of interest to the Federal Office of Rural Health Policy (FORHP) and Flex Program for identifying and understanding programmatic improvement across initiatives, prioritizing areas of need, targeting technical support, and guiding future iterations of the Flex Program.

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Authorizing Statute(s): US Code: 42 USC 711 Name of Law: Social Security Act
   PL: Pub.L. 111 - 352 2142 Name of Law: GPRA Modernization Act of 2010
  

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:
	80 FR 101	05/27/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 30	02/16/2016
Did the Agency receive public comments on this ICR? Yes

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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
Medicare Rural Hospital Flexibility Grant Program Performance Measures	1	1

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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	45	45	0	0	0	0
Annual Time Burden (Hours)	3,150	9,720	0	-6,570	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: Changing Forms

Short Statement: The measures have been revised and the burden to respondents has been reduced.

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Annual Cost to Federal Government: $9,720

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: 03/03/2016

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