PRECLEARANCE: EVALUATION OF SOCIAL/HEALTH MAINTENANCE ORGANIZATION (S/HMO) DEMONSTRATION

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
113622	PRECLEARANCE: EVALUATION OF SOCIAL/HEALTH MAINTENANCE ORGANIZATION (S/HMO) DEMONSTRATION Form	Migrated

ICR Details

OMB Control No: 0938-0385	ICR Reference No: 198408-0938-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: PRECLEARANCE: EVALUATION OF SOCIAL/HEALTH MAINTENANCE ORGANIZATION (S/HMO) DEMONSTRATION
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/21/1984
	Date Received in OIRA: 08/23/1984
Terms of Clearance: DUE TO THE IMPORTANCE PLACED ON THE DEMONSTRATION BY CONGRESS AND THE NEED TO HAVE STATISTICALLY VALID DATA FROM WHICH THE COST-EFFECTIVENES AND NATIONAL APPLICABILITY CAN BE ASSESSED, PRECLEARANCE APPROVAL IS CONDITIONED ON THE FOLLOWING REQUIREMENTS TO ASSURE THE PRACTICAL UTILITY OF THE DEMONSTRATION AND EVALUATION: 1. THE CONTRACT MUST INCLUDE THE FOLLOWING MANDATORY DELIVERABLES: A. MEASUREMENT OF FULL FEDERAL COSTS INCLUDING, BUT NOT LIMITED TO, MEDICARE, MEDICAID, SSI, AND TITLE XX B. DESIGN AND IMPLEMENTATION OF A METHODOLOGICALLY SOUND, STATISTICALLY VALID CONTROL GROUP WHICH PERMITS DRAWING INFERENCES ABOUT DIFFERENCES IN NURSING HOME UTILIZATION AND COSTS WHICH WOULD BE EQUIVALENT TO THOSE THAT COULD BE DRAWN FROM A RANDOMIZED CONTROL. 2. HCFA WILL SUBMIT TO OMB A LIST OF OPERATIONAL HYPOTHESES THAT MUST BE TESTED FOR SUCCESSFUL COMPLETION OF THE EVALUATION CONTRACT WITHIN ONE MONTH OF THIS APPROVAL.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/1985	09/30/1985
Responses	5,000	0	0
Time Burden (Hours)	15,834	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: THIS PROJECT EVALUATES THE EFFECT OF THE S/HMO ON THE COST AND USE OF ACURE CARE AND LONG-TERM CARE SERVICES PROVIDED TO MEDICARE S/HMO ENROLLEES COMPARED WITH A FEE-FOR-SERVICE CONTROL GROUP. BENEFICIARIES' HEALTH STATUS, INFORMAL SUPPORT NETWORKS, CASE-MANAGEME AND SATISFACTION WITH S/HMO SERVICE WILL BE MEASURED USING A LONGITUDINAL DESIGN.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
PRECLEARANCE: EVALUATION OF SOCIAL/HEALTH MAINTENANCE ORGANIZATION (S/HMO) DEMONSTRATION	HCFA-413

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ICR Summary 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	5,000	0	0	0	5,000	0
Annual Time Burden (Hours)	15,834	0	0	0	15,834	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:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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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: 08/23/1984

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