Review of National Coverage Determinations and Local Coverage Determinations and Supporting Regulations in 42 CFR, Sections 426.400 and 426.500

Forms and Documents

Document Name	Status
CMS-10099 Supporting Statement 2007.doc Supporting Statement A	0000-00-00

IC Document Collections

IC ID	Document Title	Status
8751	Review of National Coverage Determinations and Local Coverage Determinations and Supporting Regulations in 42 CFR, Sections 426.400 and 426.500	Modified

ICR Details

OMB Control No: 0938-0911	ICR Reference No: 200703-0938-016
Status: Historical Active	Previous ICR Reference No: 200311-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Review of National Coverage Determinations and Local Coverage Determinations and Supporting Regulations in 42 CFR, Sections 426.400 and 426.500
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/17/2007
	Date Received in OIRA: 03/30/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2010	36 Months From Approved	07/31/2007
Responses	1,040	0	1,040
Time Burden (Hours)	4,160	0	4,160
Cost Burden (Dollars)	0	0	0

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Abstract: Section 522 of the Benefits Improvement and Protection Act (BIPA) of 2000 requires the implementation of a process for the appeal of National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). The Final Rule revises, refines, and finalizes the process proposed in the Notice of Proposed Rulemaking, published in August 2002.

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Authorizing Statute(s): PL: Pub.L. 106 - 554 522 Name of Law: Benefis Improvement and Protection Act (BIPA)
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AK60	Final or interim final rulemaking	68 FR 63692	11/07/2003

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 3852	01/26/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 15139	03/30/2007
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
Review of National Coverage Determinations and Local Coverage Determinations and Supporting Regulations in 42 CFR, Sections 426.400 and 426.500

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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	1,040	1,040	0	0	0	0
Annual Time Burden (Hours)	4,160	4,160	0	0	0	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: 03/30/2007

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