ESRD Beneficiary Selection and Supporting Regulations Contained in 42 CFR 414.330

Forms and Documents

Document Name	Status
Form CMS-382 ESRD Beneficiary Selection and Supporting Regulations Contained in 42 CFR 414.330 Form and Instruction	Modified
SSN Justification for CMS-382 form.doc Supplementary Document	2007-11-19
CMS-382 Supporting statement for CMS-382 package.doc Supporting Statement A	2007-11-19

IC Document Collections

IC ID	Document Title	Status
8010	ESRD Beneficiary Selection and Supporting Regulations Contained in 42 CFR 414.330 Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0372	ICR Reference No: 200712-0938-002
Status: Historical Active	Previous ICR Reference No: 200411-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: ESRD Beneficiary Selection and Supporting Regulations Contained in 42 CFR 414.330
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: 06/12/2008
	Date Received in OIRA: 12/17/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2011	36 Months From Approved	06/30/2008
Responses	7,400	0	7,400
Time Burden (Hours)	617	0	617
Cost Burden (Dollars)	0	0	0

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Abstract: The intermediaries and carriers are responsible for making correct payments of all renal dialysis claims under the Medicare program. The intermediaries and carriers determine payment for home dialysis services and supplies according to the methods selected by the beneficiary. Sixty (60) percent of the beneficiaries choose Method I. The intermediaries only pay for beneficiaries listed under Method I (composite rate). The remaining Forty (40) percent choose Method II. Under Method II, the beneficiary selects a single supplier to furnish needed equipment and supplies, and the supplier bills the carrier for payment.

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Authorizing Statute(s): US Code: 42 USC 1395 Name of Law: Medicare Coverage for End Stage Renal Disease Patients
  

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:
	72 FR 48645	08/24/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 64653	11/16/2007
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
ESRD Beneficiary Selection and Supporting Regulations Contained in 42 CFR 414.330	CMS-382	ESRD Beneficiary Selection

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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	7,400	7,400	0	0	0	0
Annual Time Burden (Hours)	617	617	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: $9,250

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: 12/17/2007

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