(CMS-10279) Ambulatory Surgical Centers Conditions of Coverage

Forms and Documents

Document Name	Status
CMS-10279 Final Supporting Statement 7-28-17.docx Supporting Statement A	2017-08-01

IC Document Collections

IC ID	Document Title	Status
189557	Ambulatory Surgical Centers Conditions of Coverage (416.50)(a)(3)	Modified
189556	Ambulatory Surgical Centers Conditions of Coverage (416.50)(a)(1)	Modified
189555	Ambulatory Surgical Centers Conditions of Coverage (416.43)	Modified
189554	Ambulatory Surgical Centers Conditions of Coverage (416.41)	Modified

ICR Details

OMB Control No: 0938-1071	ICR Reference No: 201704-0938-009
Status: Historical Active	Previous ICR Reference No: 201309-0938-020
Agency/Subagency: HHS/CMS	Agency Tracking No: 20480
Title: (CMS-10279) Ambulatory Surgical Centers Conditions of Coverage
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 with change	Conclusion Date: 08/15/2017
	Date Received in OIRA: 04/28/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2020	36 Months From Approved	08/31/2017
Responses	22,000	0	21,200
Time Burden (Hours)	214,500	0	206,700
Cost Burden (Dollars)	0	0	0

---

Abstract: This information collection package is a request for extension of information collection requirements. With this submission, we have updated the current number of Ambulatory Surgical Centers and wages/salary figures. The information collection requirements, as discussed in the supporting statement, are needed to implement the Medicare and Medicaid Conditions for Coverage for 5500 Ambulatory Surgical Centers.

---

Authorizing Statute(s): PL: Pub.L. 96 - 499 934 Name of Law: Outpatient Surgery
  

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:
	82 FR 11040	02/17/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 19734	04/28/2017
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Ambulatory Surgical Centers Conditions of Coverage (416.41)
Ambulatory Surgical Centers Conditions of Coverage (416.43)
Ambulatory Surgical Centers Conditions of Coverage (416.50)(a)(1)
Ambulatory Surgical Centers Conditions of Coverage (416.50)(a)(3)

---

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	22,000	21,200	0	0	800	0
Annual Time Burden (Hours)	214,500	206,700	0	0	7,800	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: Changes to the burden are a reflection of the increase in number of Medicare certified ASCs at this time compared to the previous collection. The number of ASCs increased from 5,300 to 5,500 therefore the burden hours increased from 206,700 to 214,500. There were also changes in current average hourly rate for medical professionals used in the calculations. In addition, the figures include a 100% benefits and overhead package figured as part of their salary.

---

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 04/28/2017

---