(CMS-R-72) Information Collection Requirements in 42 CFR Sections 478.18, 478.34, 478.36, and 478.42 QIO Reconsiderations and Appeals

Forms and Documents

Document Name	Status
CMS-R-72 Supporting Statement - final 4-28-18.doc Supporting Statement A	2018-04-30

IC Document Collections

IC ID	Document Title	Status
43657	Information Collection Requirements in 42 CFR 478.18(b) - Request for reconsideration	Modified
191472	Information Collection Requirements in 42 CFR 478.42 - submitting a request for a hearing	Modified
191471	Information Collection Requirements in 42 CFR 478.36 - record of reconsideration	Modified
191470	Information Collection Requirements in 42 CFR 473.34(b) - reconsideration determination provider burden	Modified
191469	Information Collection Requirements in 42 CFR 478.34(a) - Notice of a reconsidered determination	Modified

ICR Details

OMB Control No: 0938-0443	ICR Reference No: 201804-0938-028
Status: Active	Previous ICR Reference No: 201609-0938-027
Agency/Subagency: HHS/CMS	Agency Tracking No: 20310
Title: (CMS-R-72) Information Collection Requirements in 42 CFR Sections 478.18, 478.34, 478.36, and 478.42 QIO Reconsiderations and Appeals
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 without change	Conclusion Date: 12/03/2018
	Date Received in OIRA: 04/30/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	36 Months From Approved	11/30/2018
Responses	60,729	0	7,584
Time Burden (Hours)	22,014	0	2,822
Cost Burden (Dollars)	0	0	0

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Abstract: These regulations contain procedures for QIOs (formerly known as PROs) to use in reconsideration of initial determinations. The information requirements contained in these regulations are on QIOs to provide information to parties requesting a reconsideration. These parties will use the information as guidelines for appeal rights in instances where issues are still in dispute.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Research and investigations generally
  

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:
	83 FR 8679	02/28/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 18847	04/30/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Information Collection Requirements in 42 CFR 478.18(b) - Request for reconsideration
Information Collection Requirements in 42 CFR 478.34(a) - Notice of a reconsidered determination
Information Collection Requirements in 42 CFR 473.34(b) - reconsideration determination provider burden
Information Collection Requirements in 42 CFR 478.36 - record of reconsideration
Information Collection Requirements in 42 CFR 478.42 - submitting a request for a hearing

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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	60,729	7,584	0	0	53,145	0
Annual Time Burden (Hours)	22,014	2,822	0	0	19,192	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 number of responses increased from 7,584 to 60,729. The burden hours increased from 2,822 to 22,014.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 04/30/2018

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