Electronic Funds Transfer Authorization Agreement (CMS-588)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-588 Electronic Funds Transfer	Form and Instruction	Modified	Available
Form CMS-588 Electronic Funds Transfer Authorization Agreement	Form and Instruction	Modified	Repair queued
CMS-588 - Supporting Statemen t.docx	Supporting Statement A	Uploaded 2023-05-11	Repair queued
CMS-588 - Crosswalk of Changes.xlsx	Supplementary Document	Uploaded 2023-05-10	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43660	Electronic Funds Transfer Authorization Agreement	Form and Instruction	Modified	Electronic Funds Transfer
43660	Electronic Funds Transfer Authorization Agreement	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0626	ICR Reference No: 202305-0938-005
Status: Active	Previous ICR Reference No: 201912-0938-021
Agency/Subagency: HHS/CMS	Agency Tracking No: CPI - 588
Title: Electronic Funds Transfer Authorization Agreement (CMS-588)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/13/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/15/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2026	36 Months From Approved	12/31/2023
Responses	82,807	0	115,833
Time Burden (Hours)	56,037	0	57,917
Cost Burden (Dollars)	0	0	0

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Abstract: The primary function of the Electronic Funds Transfer Authorization Agreement (CMS 588) is to gather information from a provider/supplier to establish an electronic payment process. The legal authority to collect this information is found in Section 1815(a) of the Social Security Act. This section provides authority for the Secretary of Health and Human Services to pay providers/suppliers of Medicare services. Under 31 U.S.C. 3332(f)(1), all Federal payments, including Medicare payments to providers and suppliers, shall be made by electronic funds transfer. 31 U.S.C. 7701 (c) requires that any person or entity doing business with the Federal Government must provide their Tax Identification Number (TIN). Goal of the Provider/Supplier Enrollment Application Revisions The goal of evaluating and revising the CMS 588 agreement is to renew the data collection. Due to previous revisions (2006 and 2009), this form is user friendly and concise. Only two minor revisions for systems requirements will be made at this time, specifically adding a street address line for the location of the financial institution and adding an additional National Provider Identification (NPI) number collection field for those providers/suppliers who have more than one NPI.

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Authorizing Statute(s): US Code: 31 USC 7701(c) Name of Law: Tax Payer Identification Number
   US Code: 31 USC 3332(f)(1) Name of Law: Required Direct Deposit
  

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 78685	12/22/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 29671	05/08/2023
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
Electronic Funds Transfer Authorization Agreement	CMS-588	Electronic Funds Transfer

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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	82,807	115,833	0	0	-33,026	0
Annual Time Burden (Hours)	56,037	57,917	0	0	-1,880	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: Burden has increased by +1,880 hours (from 57,917 to 56,037 hours). According to the PECOS system, there was a decrease of -33,026 respondents (115,833 to 82,807). In addition, the time per response increased by +.08 hours which offset the total burden change.

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Annual Cost to Federal Government: $1,521

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.     Yes

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.     Yes

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: 05/15/2023

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