CROWNWeb Authentication Service (CAS) Account Form

Forms and Documents

Document Name	Status
Form CMS-10267 CROWNWeb Authentication Service (CAS) Account Form (2nd and 3rd Year) Form and Instruction	New
Form CMS-10267 CROWNWeb Authentication Service (CAS) Account Form (First Year) Form and Instruction	New
IDM_7.1.1._qualiltynet.BMP Supplementary Document	2008-08-12
IDM_7.1.1._identity_info.BMP Supplementary Document	2008-08-12
IDM_7.1.1._business_info.BMP Supplementary Document	2008-08-12
IDM_7.1.1._basic_info.BMP Supplementary Document	2008-08-12
Request for Review and Approval of an Emergency Justification.txt Supplementary Document	2008-08-12
CMS-CAS Justification for Emergency Clearance-Final Version-5-12-2008.doc Supplementary Document	2008-08-12
CMS-10267.Supporting Statement CAS - Part A (REVISED).doc Supporting Statement A	2008-08-12

IC Document Collections

IC ID	Document Title	Status
186127	CROWNWeb Authentication Service (CAS) Account Form (2nd and 3rd Year) Form and Instruction	New
186126	CROWNWeb Authentication Service (CAS) Account Form (First Year) Form and Instruction	New

ICR Details

OMB Control No: 0938-1050	ICR Reference No: 200808-0938-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: CROWNWeb Authentication Service (CAS) Account Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 08/29/2008
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/01/2008
	Date Received in OIRA: 08/13/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2009	6 Months From Approved
Responses	15,600	0	0
Time Burden (Hours)	7,800	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Office of Clinical Standards and Quality (OCSQ) is replacing two legacy applications that collect information for the CMS-2728 End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration (OMB No. 0938-0046) and the CMS-2746 ESRD Death Notification (OMB No. 0938-0448). The new system, replacing these two legacy applications, is known as the "Consolidated Renal Operations in a Web Enabled Network (CROWNWeb)." CROWNWeb is the system that is mandated for the Final Rule published April 15, 2008, with the title "Medicare and Medicaid Programs Conditions for Coverage for End-Stage Renal Disease Facilities." Due to the sensitivity of the data available in CROWNWeb, CMS must ensure that only authorized dialysis facility and ESRD Network Organization personnel have access to CROWNWeb data and that only data pertaining to their own patients is available to facility personnel. The CROWNWeb Authentication System (CAS) is the system that will be used in creating and maintaining these CROWNWeb user accounts.

Emergency Justfication: Please see attached document.

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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:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 32337	06/06/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
CROWNWeb Authentication Service (CAS) Account Form (First Year)	CMS-10267	CAS Account Form
CROWNWeb Authentication Service (CAS) Account Form (2nd and 3rd Year)	CMS-10267	CAS Account Form

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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	15,600	0	0	15,600	0	0
Annual Time Burden (Hours)	7,800	0	0	7,800	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: This is a new collection.

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Annual Cost to Federal Government: $324,000

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: 08/13/2008

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