Medicare Participating Physician or Supplier Agreement (CMS-460)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-460 Medicare Participating Physician or Supplier Agreement	Form and Instruction	Modified	Repair queued
CMS-460.Supporting Statement Part A.docx	Supporting Statement A	Uploaded 2022-07-15	Repair queued
2022 CMS 460 Crosswalk.pdf	Supplementary Document	Uploaded 2022-07-13	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8015	Medicare Participating Physician or Supplier Agreement	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0373	ICR Reference No: 202207-0938-006
Status: Received in OIRA	Previous ICR Reference No: 201909-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: Medicare Participating Physician or Supplier Agreement (CMS-460)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/18/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2022
Responses	36,000	29,000
Time Burden (Hours)	9,000	7,250
Cost Burden (Dollars)	0	0

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Abstract: The CMS-460 is completed by nonparticipating physicians and suppliers if they choose to participate in Medicare Part B. By signing the agreement, the physician or supplier agrees to take assignment on all Medicare claims. To take assignment means to accept the Medicare allowed amount as payment in full for the services they furnish and to charge the beneficiary no more than the deductible and coinsurance for the covered service. In exchange for signing the agreement, the physician or supplier receives a signficiant number of program benefits not available to nonparticipating suppliers. The information associated with this collection is needed to identify the recipients of the program benefits.

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Authorizing Statute(s): PL: Pub.L. 98 - 369 a Name of Law: The Deficit Reduction Act of 1984
  

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:
	87 FR 26359	05/04/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 42484	07/15/2022
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
Medicare Participating Physician or Supplier Agreement	CMS-460	Medicare Participating Provider or Supplier Agreement

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ICR Summary of Burden

table that charts list of burden

	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	36,000	29,000	0	0	7,000	0
Annual Time Burden (Hours)	9,000	7,250	0	0	1,750	0
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 burden per response remains unchanged, however, the annual burden has been adjusted based on the availability of recent data. Approximately 36,000 entities (6% annual increase since the previous collection) submitted new participation agreements for a total burden to the public of 9,000 hours. This resulted in an increase in annual burden from 7,250 to 9,000.

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Annual Cost to Federal Government: $471,645

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? No

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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: 07/18/2022

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