(CMS-R-43) Medicare and Medicaid Programs: Conditions of Participation for Portable X-ray Suppliers

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-R-43 Supporing Statement - 12-19-17.docx	Supporting Statement A	Uploaded 2018-07-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7973	Conditions of Participation for Portable X-ray Suppliers and Supporting Regulations in 42 CFR Section 486.104		Modified
185717	Conditions of Participation for Portable X-ray Suppliers and Supporting Regulations in 42 CFR Section 486.110		Modified
185716	Conditions of Participation for Portable X-ray Suppliers and Supporting Regulations in 42 CFR Section 486.106		Modified

ICR Details

OMB Control No: 0938-0338	ICR Reference No: 201807-0938-004
Status: Active	Previous ICR Reference No: 201307-0938-019
Agency/Subagency: HHS/CMS	Agency Tracking No: 20136
Title: (CMS-R-43) Medicare and Medicaid Programs: Conditions of Participation for Portable X-ray Suppliers
Type of Information Collection: Reinstatement with change of a previously 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: 07/18/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	36 Months From Approved
Responses	1,527	0	0
Time Burden (Hours)	532,959	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The information is required to certify portable X-ray suppliers wishing to participate in the Medicare program. The information collection is needed to determine if portable X-ray suppliers are in compliance with published health and safety requirements. This is standard medical practice and is necessary in order to ensure the well-being and safety of patients and professional treatment accountability.

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Authorizing Statute(s): None

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 15389	04/10/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 32667	07/13/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Conditions of Participation for Portable X-ray Suppliers and Supporting Regulations in 42 CFR Section 486.106
Conditions of Participation for Portable X-ray Suppliers and Supporting Regulations in 42 CFR Section 486.104
Conditions of Participation for Portable X-ray Suppliers and Supporting Regulations in 42 CFR Section 486.110

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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	1,527	0	0	0	-207	1,734
Annual Time Burden (Hours)	532,959	0	0	0	532,011	948
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 changes to the burden hours are primarily due to public comments that CMS received. The comments, submitted by two entities during the public comment period for the CY 2018 SNF PPS proposed rule (82 FR 36530), stated that there is a conflict between the documentation required for portable X-ray orders and other diagnostic test. Accounting for these new burdens increased the estimate by 532,055 hours and $26,908.588. Additionally, the salary estimate per burden hour increased by $15.10 in order to account for wage increases and to add in a 100% salary and benefits package. Finally, the burden estimates were revised in order to reflect a decrease in the number of portable X-ray suppliers from 578 to 509.

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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: 07/18/2018

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