Assurance and Certification of Compliance (NPRM)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HHS Form 690 Assurance of Compliance	Form and Instruction	Modified	Available
Form HHS Form 690 Assurance of Compliance	Form and Instruction	Modified	Repair queued
0945-0008 Supporting document for 690 complaint form_proofed 02-28-23 rev.docx	Supporting Statement A	Uploaded 2023-03-01	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
238746	Assurance of Compliance	Form and Instruction	Modified	Assurance of Compliance
238746	Assurance of Compliance	Form and Instruction	Modified
236662	Assurance and Certification Requirements	Other-form	Unchanged
229949	88.4(a) (Update Policies and Procedures; Train Workforce)		Unchanged
229948	88.4(a) (Review Policies and Procedures)		Unchanged
229875	88.4(a) (Review and sign assurance and certification)		Unchanged

ICR Details

OMB Control No: 0945-0008	ICR Reference No: 202302-0945-001
Status: Historical Active	Previous ICR Reference No: 201906-0945-003
Agency/Subagency: HHS/OCR	Agency Tracking No:
Title: Assurance and Certification of Compliance (NPRM)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/03/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/01/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2026	36 Months From Approved
Responses	360,231	0	0
Time Burden (Hours)	1,317,646	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Requiring certain recipients and applicants to assure and certify compliance serves two purposes. First, through the act of reading and reviewing the statutory requirements to which recipients or applicants assure and certify compliance, recipients would be apprised of their obligations under the applicable Federal health care conscience and associated anti-discrimination laws. Second, a recipient’s or applicant’s awareness of its obligation would increase the likelihood that it would comply with such laws and consequently afford entities and individuals protection of their conscience rights and protection from coercion or discrimination. Because of this awareness, the Department anticipates that proposed § 88.4 may generate changes in the policies, procedures, and operations of the persons and entities covered

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Authorizing Statute(s): US Code: 42 USC 238n Name of Law: Coats-Snowe Amendment,
   PL: Pub.L. 115 - 31 507(d) Name of Law: Consolidated Appropriations Act
   PL: Pub.L. 131 - 135 209 Name of Law: Weldon language applied to Medicare Advantage
   US Code: 42 USC 18023(c) Name of Law: Affordable Care Act
   US Code: 42 USC 300a-7 Name of Law: Church Amendment
  

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 66199	11/02/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 2362	01/13/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
88.4(a) (Review Policies and Procedures)
88.4(a) (Review and sign assurance and certification)
88.4(a) (Update Policies and Procedures; Train Workforce)
Assurance and Certification Requirements
Assurance of Compliance	HHS Form 690	Assurance of Compliance

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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	360,231	0	0	-500,290	9,595	850,926
Annual Time Burden (Hours)	1,317,646	0	0	-2,501,450	38,380	3,780,716
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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The decrease in the number of respondents is due to a lower number of respondents anticipated than in recent years through the OCR website and through paper submissions.

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Annual Cost to Federal Government: $514,963

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]? Yes

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: 03/01/2023

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