Electronic Visit Verification (EVV) Compliance Survey (CMS-10680)

ICR 202206-0938-020

OMB: 0938-1360

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2022-06-29
Supporting Statement B
2022-06-29
Supporting Statement A
2022-06-29
IC Document Collections
ICR Details
0938-1360 202206-0938-020
Received in OIRA 201902-0938-010
HHS/CMS CMCS
Electronic Visit Verification (EVV) Compliance Survey (CMS-10680)
Revision of a currently approved collection   No
Regular 06/29/2022
  Requested Previously Approved
36 Months From Approved 06/30/2022
168 336
252 504
0 0

This collection entails an electronic, web-based survey that will allow states to self-report their progress in implementing electronic visit verification (EVV) for personal care services (PCS) and home health care services (HHCS), as required by section 1903(l) of the Social Security Act. The Center for Medicare and Medicaid Services (CMS) will use the survey data to assess states’ compliance with section 1903(l) of the Act and levy FMAP reductions where necessary as required by 1903(l) of the Act. Data collection will begin in November 2019 and will end when all states have fully implemented EVV systems according to the requirements specified at section 1903(l) of the Act.

US Code: 42 USC 1903(l) Name of Law: Social Security Act
  
None

Not associated with rulemaking

  87 FR 21887 04/13/2022
87 FR 38411 06/28/2022
Yes

1
IC Title Form No. Form Name
Electronic Visit Verification (EVV) Compliance Survey CMS-10680, CMS-10680 EVV Home Health Care Services (HHCS) Survey ,   EVV Personal Care Services (PCS) Survey

  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 168 336 0 0 -168 0
Annual Time Burden (Hours) 252 504 0 0 -252 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Burden estimates for states are reduced from $33,970 to $18,608. The estimate is reduced because all states and territories have completed their initial survey response for PCS. In addition, fewer survey updates are estimated because 75 percent of states are fully compliant for PCS and are no longer required to update the survey to report their compliance status.

$155,334
No
    No
    No
No
No
No
No
Mitch Bryman 410 786-5258 [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.
06/29/2022


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