(CMS-3427) End Stage Renal Disease Application and Survey and Certification Report Form and Supporting Regulations

ICR 202205-0938-004

OMB: 0938-0360

Federal Form Document

ICR Details
0938-0360 202205-0938-004
Received in OIRA 202002-0938-003
HHS/CMS CCSQ
(CMS-3427) End Stage Renal Disease Application and Survey and Certification Report Form and Supporting Regulations
Reinstatement with change of a previously approved collection   No
Regular 05/04/2022
  Requested Previously Approved
36 Months From Approved
2,601 0
866 0
0 0

This form is a facility identification and screening measurement used to initiate the certification and recertification of ESRD facilities.

PL: Pub.L. 92 - 602 2991 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  87 FR 8842 02/16/2022
87 FR 25644 05/02/2022
No

  Total Request 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 2,601 0 0 128 0 2,473
Annual Time Burden (Hours) 866 0 0 42 0 824
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The number of respondents increased from 2,473 to 2,601. Burden hours increased from 824 hours to 866 hours

$193
No
    No
    No
No
No
No
No
Denise King 410 786-1013 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
05/04/2022


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