Restraint and Seclusion Standards for Psychiatric Residential Treatment Facilities (CMS-R-306)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-R-306 Restraint and Seclusion Standards for Psychiatric Residential Treatment Facilities	Form	Modified	Available
CMS-R-306 - Supporting Statement A (version 2).docx	Supporting Statement A	Uploaded 2019-01-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8633	Restraint and Seclusion Standards for Psychiatric Residential Treatment Facilities	Form	Modified

ICR Details

OMB Control No: 0938-0833	ICR Reference No: 201901-0938-011
Status: Active	Previous ICR Reference No: 201505-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: Restraint and Seclusion Standards for Psychiatric Residential Treatment Facilities (CMS-R-306)
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 with change	Conclusion Date: 05/28/2019
	Date Received in OIRA: 01/31/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2022	36 Months From Approved
Responses	1,353,993	0	0
Time Burden (Hours)	414,944	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Psychiatric residential treatment facilities are required to report deaths, serious injuries and attempted suicides to State Medicaid Agency and Protection and Advocacy Organization. Also required to provide residents restraint and seclusion policy in writing, and to document resident record of all activities involving use of restraint and seclusion.

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Authorizing Statute(s): US Code: 42 USC 483.350 Name of Law: Public Health - General requirements for PRTFs/Subpart G
  

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 28429	06/19/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 734	01/31/2019
Did the Agency receive public comments on this ICR? No

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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
Restraint and Seclusion Standards for Psychiatric Residential Treatment Facilities	CMS-R-306	Death Reporting Worksheet

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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	1,353,993	0	0	0	-112,830	1,466,823
Annual Time Burden (Hours)	414,944	0	0	0	-34,665	449,609
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: While we have not revised our per response burden estimates, we have adjusted the number of respondents from 390 to 360. The result adjusts our total time estimate by minus 34,665 hours. The number of respondents for §§483.56(c), 483.374(a), and 483.374(c) remains unchanged as does their respective total time figures of 112 hr, 112, hr and 0.42 hr. We also added a reporting worksheet which is an internal CMS form that is not required by State Medicaid Agencies.The per response reporting burden is currently approved by OMB and remains unchanged.

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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: 01/31/2019

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