OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

In-Center Hemodialysis CAHPS Survey

ICR 201307-0938-002 · OMB 0938-0926 · Historical Active

Forms and Documents
Document
Name
Status
Form
 Modified
Form
 New
Supporting Statement B
2013-07-05
Supplementary Document
2013-07-05
Supplementary Document
2013-07-05
Supplementary Document
2013-07-05
Supplementary Document
2013-07-05
Supplementary Document
2013-07-05
Supplementary Document
2013-07-05
Supporting Statement A
2013-07-05
IC Document Collections
IC ID
Document
Title
Status
8773 Modified
207671 New
ICR Details
0938-0926 201307-0938-002
Historical Active 200407-0938-004
HHS/CMS 19941
In-Center Hemodialysis CAHPS Survey
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 09/20/2013
Retrieve Notice of Action (NOA) 07/09/2013
  Inventory as of this Action Requested Previously Approved
09/30/2016 36 Months From Approved
325,000 0 0
87,750 0 0
0 0 0
Administration of In-center Hemodialysis CAHPS(ICH CAHPS) survey by more than 5,700 Medicare-certified ESRD facilities is now required as part of the value-based purchasing program for payments under the Medicare program, as described in the 2012 proposed and final ESRD Prospective System Payment Update Rules published in the Federal Register on July 8, 2011, and November 10, 2011, respectively. Value-based purchasing promotes CMS' goals: better healthcare for individuals; better care for populations and communities; and, lower costs through improvement. Beginning in CY2014, ICH facilities will be required to contract with a CMS-approved survey vendor to implement the survey; the CMS-approved vendor shall follow a set of standardized survey administration procedures developed for national implementation. Survey results from the national implementation will be publicly reported on the DFC website on www.medicare.gov.
US Code: 42 USC 1881(h) Name of Law: Social Security Act
  
None
Not associated with rulemaking
  78 FR 23566 04/19/2013
78 FR 38983 06/28/2013
No
  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 325,000 0 0 325,000 0 0
Annual Time Burden (Hours) 87,750 0 0 87,750 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The field test burden was discontinued in 2007. This is a Reinstatement that adds burden associated with the mode experiment and the national implementation. While the overall burden has increased from adding the mode experiment and the national implementation, the annual (per response) burden for the mode experiment and national implementation have decreased. The hours per response for the field test were approximately .50 hr, compared to the estimated .27 hr for both the ICH CAHPS Survey mode experiment and national implementation.
$0
Yes Part B of Supporting Statement
No
Yes
No
No
Uncollected
Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
07/09/2013