State Operations Manual (Pub. 100-07), Ch. 4 § 4060
Approval of Information Collected From Public by SAs - General
4060 - Approval of Information Collected From Public by SAs - General
(Rev. 1, 05-21-04)
The Paperwork Reduction Act (PRA) was enacted on December 11, 1980. Section 3512
of the Act stipulates that no member of the public may be penalized for failing to
maintain or provide information to any agency if the information collection request does
not display an approval number from OMB or does not state that such request is not
subject to the PRA. The term “agency” includes executive departments (such as CMS)
and their contractors (such as intermediaries, carriers, and SAs). The term “public”
includes all entities that are not employees of or contractors to the Federal government.
For CMS purposes, the public includes health care providers, suppliers, physicians,
beneficiaries, QIOs, and SMAs.
The CMS forms originating from CO which reference information collection should
already have OMB approval. The OMB approval number (e.g., 0938-XXXX) is printed
in the upper right-hand corner of these forms. Over the years, SAs developed other forms
subject to the PRA in response to instructions contained in CMS’ program issuances.
Thus, the actual requirement for the information resides in the program issuance manuals
approved by OMB.
In some categories, the specification of data elements may unduly limit the performance
of SAs. In these cases, OMB approval will be obtained for a more generalized collection
of information, such as an “area of inquiry.” The area of inquiry would be accompanied
by examples of data elements, typical of the area of inquiry. The SAs’ forms could use
these data elements or others of a similar nature, as long as they fall within the area of
inquiry as described in the program issuance manual and approved by OMB.
As the categories are reviewed and defined in terms of their data elements or areas of
inquiry, the program issuance will convey this information. The SAs’ forms will then be
limited to the routine collection of the data so specified.
In the future, as CMS identifies new categories of information that SAs should collect,
two areas of the program issuance manuals will be updated and reapproved by OMB.
First, the forms in the exhibits will identify the new OMB approval number and the data
elements that are to be collected. Secondly, the SA’s responsibility in collecting this
information will be described in the appropriate section of the manual.
The PRA requires the display of the OMB approval number on each form. It should be
printed in the top right-hand corner of each page as shown below. No special typesetting
is required.
Form Approved
OMB No. 0938-XXXX