Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-1095	ICR Reference No: 201112-0938-007
Status: Historical Active	Previous ICR Reference No: 201111-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Application for Coverage in the Pre-Existing Condition Insurance Plan
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/20/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/19/2011
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved. The agency is reminded that they must review and update their supporting statements with each request. If supporting statements have not been updates, OMB will improperly submit the collection. With this revision, CMS corrects an error to the prior submission that significantly overstated the number of responses.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	36 Months From Approved	12/31/2013
Responses	83,333	0	399,999
Time Burden (Hours)	59,833	0	233,999
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	83,333	399,999	-399,999	83,333
Annual Time Burden (Hours)	59,833	233,999	-233,999	59,833
Annual Cost Burden (Dollars)	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The burden associated with this information collection request (ICR) has decreased by 233,999 hours. It has been identified as a program change because of the ROCIS system. It is an adjustment. The burden has been adjusted to correct an arithmetic error. When originally submitted, this ICR was quadruple counting the burden when instead the burden should only have been listed once as it was the estimated annual burden from year to year. The downward adjustment resulted in the correct estimated annual burden of 59,883 hours.