Examination and Treatment for Emergency Medical Conditions and Women in Labor (EMTALA), 42 CFR 482.12, 488.18, 489.20, and 489.24 (R-142)

Forms and Documents

Document Name	Status
CMS-R-142_Supporting_Statement_Part_A_.pdf Supporting Statement A	2020-07-01

IC Document Collections

IC ID	Document Title	Status
8250	Examination and Treatment for Emergency Medical Conditions and Women in Labor (EMTALA), 42 CFR 482.12, 488.18, 489.20, and 489.24, & HCFA-1005-IFC, PPS for Hospital Outpatient Services,...	Modified

ICR Details

OMB Control No: 0938-0667	ICR Reference No: 202006-0938-016
Status: Active	Previous ICR Reference No: 201701-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: Examination and Treatment for Emergency Medical Conditions and Women in Labor (EMTALA), 42 CFR 482.12, 488.18, 489.20, and 489.24 (R-142)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/17/2020
	Date Received in OIRA: 07/06/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2023	36 Months From Approved
Responses	5,291	0	0
Time Burden (Hours)	5,291	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This collection contains the requirements for hospitals in effort to prevent them from inappropriately transferring individuals with emergency medical conditions, as mandated by Congress. CMS uses this information to help assure compliance with this mandate. This information is not contained elsewhere in regulations.

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Authorizing Statute(s): PL: Pub.L. 99 - 272 Title IX 9121 Name of Law: Consolidated Omnibus Budget Reconciliation Act of 1985
   US Code: 42 USC 1395 dd Name of Law: Examination and treatment for emergency medical conditions and women in laboR
  

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:
	84 FR 63880	11/19/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 39570	07/01/2020
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
Examination and Treatment for Emergency Medical Conditions and Women in Labor (EMTALA), 42 CFR 482.12, 488.18, 489.20, and 489.24, & HCFA-1005-IFC, PPS for Hospital Outpatient Services,...

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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	5,291	0	0	0	419	4,872
Annual Time Burden (Hours)	5,291	0	0	0	419	4,872
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: Burden increase to 5,291 from the previously estimated 4,872 Medicare-participating hospitals is due to the specific requirements currently applying to additional Medicare-participating hospitals, including hospitals paid under the Inpatient Prospective Payment System, critical access hospitals, children’s hospitals, psychiatric hospitals, and 6 hospitals located in the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa paid in accordance with the Tax Equity and Fiscal Responsibility Act of 1982.

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Annual Cost to Federal Government: $2,437,100

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

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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: 07/06/2020

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