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Federal forms, ICRs, and supporting documents

Information Collection Request

Hospice Conditions of Participation and Physician Narrative on the Certification or Recertification of Terminal Illness (42 CFR 418.22(b)(3))

ICR 200906-0938-010 · OMB 0938-1067 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
CMS-10277.Response to 30-day comment-9-10-09 (1000AM).doc Supplementary Document Uploaded 2009-09-10 Available
CMS-10277 Supporting_Statement_Part_A - 7.30.09.doc Supporting Statement A Uploaded 2009-07-31 Available
IC Document Collections
IC IDCollectionTypeStatusForm
189585 Hospice Conditions of Participation (418.114 - annual) New
189584 Hospice Conditions of Participation (418.114 - first year) New
189583 Hospice Conditions of Participation (418.112) New
189582 Hospice Conditions of Participation (418.110 - annual) New
189581 Hospice Conditions of Participation (418.110 - first year) New
189580 Hospice Conditions of Participation (418.106) New
189579 Hospice Conditions of Participation (418.78) New
189578 Hospice Conditions of Participation (418.76) New
189577 Hospice Conditions of Participation (418.56) New
189576 Hospice Conditions of Participation (418.52) New
ICR Details
0938-1067 200906-0938-010
Historical Active
HHS/CMS
Hospice Conditions of Participation and Physician Narrative on the Certification or Recertification of Terminal Illness (42 CFR 418.22(b)(3))
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 09/21/2009
Retrieve Notice of Action (NOA) 06/15/2009
  Inventory as of this Action Requested Previously Approved
09/30/2012 36 Months From Approved
28,720 0 0
1,339,383 0 0
0 0 0
The CoPs and accompanying requirements specified in the regulations are used by Federal or State surveyors as a basis for determining whether a hospice qualifies for approval or re-approval under Medicare. CMS and the healthcare industry believe that the availability to the hospice of the type of records and general content of records, which this regulation specifies, is standard medical practice, and is necessary in order to ensure the well-being and safety of patients and professional treatment accountability.
US Code: 42 USC 1395x Name of Law: Hospice Care; Hospice Program
   PL: Pub.L. 97 - 248 122 Name of Law: Tax Equity & Fiscal Responsibility Act
   PL: Pub.L. 101 - 239 6005(b) Name of Law: Omnibus Reconciliation Act of 1989
   PL: Pub.L. 105 - 33 Title IV, Chapter 4 Name of Law: BBA of 1997
   PL: Pub.L. 108 - 173 946 Name of Law: Medicare Prescription Drug, Improvement, & Modernization Act of 2003
  
US Code: 42 USC 1395x Name of Law: Hospice Care; Hospice Program
Not associated with rulemaking
  74 FR 10917 03/19/2009
74 FR 27041 06/05/2009
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 28,720 0 28,720 0 0 0
Annual Time Burden (Hours) 1,339,383 0 1,339,383 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a new information collection.
$0
No
No
Uncollected
Uncollected
No
Uncollected
William Parham 4107864669
  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.
06/15/2009