Physician Certifications/Recertifications in Skilled Nursing Facilities Manual Instructions and Supporting Regs.

Forms and Documents

Document Name	Status
CMS-R-5 - Supporting Statement Part A-2016-rev-12-9-16-ks.doc Supporting Statement A	2016-12-14

IC Document Collections

IC ID	Document Title	Status
43658	Physician Certifications/Recertifications	Unchanged
190006	Physician Initial Certification	Unchanged

ICR Details

OMB Control No: 0938-0454	ICR Reference No: 201612-0938-016
Status: Historical Active	Previous ICR Reference No: 201610-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-R-5
Title: Physician Certifications/Recertifications in Skilled Nursing Facilities Manual Instructions and Supporting Regs.
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/19/2017
	Date Received in OIRA: 12/15/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2020	36 Months From Approved
Responses	2,711,136	0	0
Time Burden (Hours)	624,515	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Medicare, Skilled Nursing Facilities. 42 CFR 424.20 requires SNFs to keep record of physician certifications and recertification of information such as the need for care and services, estimated duration of the SNF stay, and plan for home care.

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Authorizing Statute(s): PL: Pub.L. 101 - 239 1814(a)(2) Name of Law: Requirement of Requests and Certifications
  

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:
	81 FR 47805	07/22/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 69828	10/07/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Physician Certifications/Recertifications
Physician Initial Certification

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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	2,711,136	0	0	0	-68,558	2,779,694
Annual Time Burden (Hours)	624,515	0	0	0	-17,130	641,645
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 change in burden is due to a decrease in number of responses based on more current data utilized

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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: 12/15/2016

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