Restraint and Seclusion Standards for Psychiatric Residential Treatment Facilities (CMS-R-306)

Forms and Documents

Document Name	Status
CMS-R-306 - Summary Statement A [rev 05-04-2015 by OSORA PRA].docx Supporting Statement A	2015-05-04

IC Document Collections

IC ID	Document Title	Status
8633	Restraint and Seclusion Standards for Psychiatric Residential Treatment Facilities	Modified

ICR Details

OMB Control No: 0938-0833	ICR Reference No: 201505-0938-002
Status: Historical Active	Previous ICR Reference No: 201207-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Restraint and Seclusion Standards for Psychiatric Residential Treatment Facilities (CMS-R-306)
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 without change	Conclusion Date: 06/10/2015
	Date Received in OIRA: 05/04/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2018	36 Months From Approved	07/31/2015
Responses	1,466,823	0	1,414,141
Time Burden (Hours)	449,609	0	415,668
Cost Burden (Dollars)	0	0	0

---

Abstract: Psychiatric residential treatment facilities are required to report deaths, serious injuries and attempted suicides to State Medicaid Agency and Protection and Advocacy Organization. Also required to provide residents restraint and seclusion policy in writing, and to document resident record of all activities involving use of restraint and seclusion.

---

Authorizing Statute(s): US Code: 42 USC 483.350 Name of Law: Public Health - General requirements for PRTFs/Subpart G
  

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:
	80 FR 5118	01/30/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 24935	05/01/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Restraint and Seclusion Standards for Psychiatric Residential Treatment Facilities

---

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	1,466,823	1,414,141	0	0	52,682	0
Annual Time Burden (Hours)	449,609	415,668	0	0	33,941	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: There are no program changes. However, burden estimates have been adjusted. Specifically, the number of facilities meeting the PRTF requirements at 42 CFR 440.160 has increased slightly since 2011 (from 376 to 390). This increase is reflected in the adjusted burden hours: 415,668 in 2012 to 449,609 in 2015. Also, the costs have been adjusted to account for the most recent BLS wage estimates.

---

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: 05/04/2015

---