(CMS-R-38) Medicare and Medicaid Programs: Conditions for Certification for Rural Health Clinics and Conditions for Coverage for FQHCs in 42 CFR 491

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS R-38 Supporting Statement 3-11-2020.docx	Supporting Statement A	Uploaded 2020-03-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7968	491.9(b) Patient Care Policies - New RHCs		Unchanged
45407	491.9(b) Patient Care Policies - Existing RHCs		Unchanged
233902	491.11 - Program Evaluation - Existing FHQCs		Unchanged
233900	491.11 - Program Evaluation - New FQHCs		Unchanged
233897	491.9(b) - Patient Care Policies - Existing FQHCs		Unchanged
233896	491.9(b) Patient Care Policies - New FQHCs		Unchanged
190717	491.11 Program Evaluation - Existing RHCs		Unchanged
190716	491.11 - Program Evaluation - New RHCs		Unchanged

ICR Details

OMB Control No: 0938-0334	ICR Reference No: 202002-0938-011
Status: Active	Previous ICR Reference No: 201810-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No: 20561
Title: (CMS-R-38) Medicare and Medicaid Programs: Conditions for Certification for Rural Health Clinics and Conditions for Coverage for FQHCs in 42 CFR 491
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/13/2020
	Date Received in OIRA: 02/21/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2023	36 Months From Approved	06/30/2020
Responses	24,928	0	8,656
Time Burden (Hours)	69,270	0	37,216
Cost Burden (Dollars)	0	0	0

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Abstract: This information is needed to determine if rural health clinics and federally qualified health centers meet the requirements to participate in the Medicare Program.

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Authorizing Statute(s): US Code: 42 USC 1395 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AT23	Final or interim final rulemaking	84 FR 51732	09/30/2019

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
491.9(b) Patient Care Policies - New FQHCs
491.9(b) - Patient Care Policies - Existing FQHCs
491.11 - Program Evaluation - New FQHCs
491.11 - Program Evaluation - Existing FHQCs
491.9(b) Patient Care Policies - New RHCs
491.9(b) Patient Care Policies - Existing RHCs
491.11 - Program Evaluation - New RHCs
491.11 Program Evaluation - Existing RHCs

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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	24,928	8,656	0	16,272	0	0
Annual Time Burden (Hours)	69,270	37,216	0	32,054	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: These ICRs have been updated in accordance with the finalized regulations at 84 FR 51732. These burden estimates are unchanged from what was estimated for the proposed rule, which was an annual burden of 69,270 hours.

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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: 02/21/2020

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