The Fiscal Soundness Reporting Requirements

Forms and Documents

Document Name	Status
OMB questions 2008 renewal of CMS 906 for 2008 (3)ja.doc Supplementary Document	2008-12-05
HPMS_FSRRElements.XLS Supplementary Document	2008-06-16
FSRR Dictionary (3)ja.doc Supplementary Document	2008-12-05
2008 OMB 83-i Supporting Statement ja.doc Supporting Statement A	2008-06-16

IC Document Collections

IC ID	Document Title	Status
8094	The Fiscal Soundness Reporting Requirements (CMS-906) Other-Sreen Shot (CMS-906)	Modified

ICR Details

OMB Control No: 0938-0469	ICR Reference No: 200806-0938-006
Status: Historical Active	Previous ICR Reference No: 200507-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: The Fiscal Soundness Reporting Requirements
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: 12/09/2008
	Date Received in OIRA: 06/19/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	36 Months From Approved	12/31/2008
Responses	700	0	370
Time Burden (Hours)	233	0	62
Cost Burden (Dollars)	0	0	0

---

Abstract: The information in this collection will be used by the financial review team in order to establish that the Medicare Advantage Organizations are maintaining fiscally sound organizations. The respondents are the Medicare Advantage Organizations.

---

Authorizing Statute(s): Statute at Large: 18 Stat. 1857 Name of Statute: null
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 17983	04/02/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 33824	06/13/2008
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
The Fiscal Soundness Reporting Requirements (CMS-906)

---

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	700	370	0	330	0	0
Annual Time Burden (Hours)	233	62	0	171	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The reason for the slight increase in burden cost was a result of moving the collection effort from a paper based approach to an on-line environment. Specifically, all MAOs are now uploading a pdf of their annual audited financial statements as well as entering 13 data elements from the corresponding statements instead of mailing in the statements. Although the burden increases slightly, CMS can now capture, track and analyze the information more completely and accurately. The on-line environment eliminates the need for MAOs to prepare packages, mail and track the financial documents.

---

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

---

Common Form ICR:  No

---

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: 06/19/2008

---