PRA Package No. 0938-832
Burden Estimate for CMS-1561 and CMS-1561A Forms
Number of CHOWS in CY 2016: 2,454
Time Burden Associated With Completion of the 1561 or 1561A forms
Time required to review statutory and regulatory law assoc. with the CMS-1561 and CMS-1561A forms
40 minutes by the facility CEO
40 minutes x 2,454 CHOWS = 98,160 minutes per all CHOWS
98,160 minutes divides by 60 min/hour = 1,636 hours per year across all facilities
Time required to fill in and sign the 1561 or 1561A form
10 min. by the facility CEO
10 minutes x 2,454 CHOWS = 24,540 minutes per all CHOWS
24,540 minutes divides by 60 min/hour = 409 hours per year across all facilities
Time required to prepare completed CMS-1561 & 1561A forms for mailing and mail
10 min by a Secretary or Office Clerk
10 minutes x 2,454 CHOWS = 24,540 minutes per all CHOWS
24,540 minutes divides by 60 min/hour = 409 hours per year across all facilities
Total time burden associated with completion of EACH CMS-1561 / 1561A form:
Time required to review statutory and regulatory law: 40 min.
Time required to fill in and sign the 1561 or 1561A form 10 min
Time required to prepare form for mailing & mail 10 min
TOTAL 60 min.
Total time burden associated with completion of ALL CMS-1561 / 1561A form:
Time required to review statutory and regulatory law: 1,636 hours
Time required to fill in and sign the 1561 or 1561A form 409 hours
Time required to prepare form for mailing & mail 409 hours
TOTAL 2,454 hours
PRA Package No. 0938-832
Revised Burden Estimate for CMS-1561 and CMS-1561A
Financial Burden Associated With Completion of the 1561 or 1561A forms
Costs Associated With Review Statutory and Regulatory Law Associated with the 1561/1561A Forms:
40 minutes of time by the facility CEO at an average executive salary of $93.44 per hour1
$93.44 divided by 60 min. = $1.56 per min.
$1.56 x 40 min = $62.40 per 40 min.
$62.40 x 2454 CHOWS per year = $153,130 per year across all facilities
Cost Required to Fill In and Sign the 1561 or 1561A Form
10 minutes of time by the facility CEO at an average executive salary of $93.44 per hour
$93.44 divided by 60 min. = $1.56 per min.
$1.56 x 10 min = $15.60 per 10 min.
$15.60 x 2,454 CHOWS per year = $38,282 per year across all facilities
Cost Associated with Preparation and Mailing of the 1561/1561A Form
10 minutes of time by a Secretary of Office Clerk as an hourly salary of $16.22 per hour2
$16.22 divided by 60 min. = $0.27 per min.
$0.27 x 10 min = $2.70 per 10 min.
$2.70 x 2,454 CHOWS per year = $6,626 per year across all facilities completing form 1561 or 1561A
Fringe Benefits
Fringe benefits in the amount of $198, 038 added to match 100% of the labor costs
($153,130 + $38,282 + $6,626 = $198,038)
Other Non-Labor Related Costs
The cost of two 1st class postage stamps at $0.50 each = $1.00
$1.00 x 2,454 CHOW = $2,454 across all facilities completing form 1561 or 1561A
PRA Package No. 0938-832
Revised Burden Estimate for CMS-1561 and CMS-1561A
Total Financial Burden Associated With Use of form 1561 and 1561(A)
Cost Required to Review Law Associated with the 1561/1561A Forms: $153,130
Cost Associated Filling In and Signing the 1561/1561A Form: $38,282
Cost Associated with Preparation and Mailing of 1561/1561A Form: $6,626
Labor Fringe Benefits $198,038
Other Non-Labor Related Costs: $2,454
Total Costs for Completion of form 1561/1561A across all new facilities: $398,530
1The wages for a facility CEO can be found on the U.S. Bureau of Labor Statistics website at https://www.bls.gov/oes/current/oes111011.htm.
2 The wages for a Medical Secretary can be found on the U.S. Bureau of Labor Statistics website at https://www.bls.gov/oes/current/oes436013.htm.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | CAROLINE GALLAHER |
| File Modified | 0000-00-00 |
| File Created | 2021-01-21 |