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: 0938-0746	ICR Reference No: 201401-0938-019
Status: Historical Active	Previous ICR Reference No: 201104-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: 21377
Title: Medicaid Disproportionate Share Hospital Annual Reporting (CMS-R-266)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/12/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/31/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved	05/31/2014
Responses	51	0	52
Time Burden (Hours)	2,142	0	1,976
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Adjustment in Estimate
Annual Number of Responses	51	52	0	-1
Annual Time Burden (Hours)	2,142	1,976	204	-38
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: No

Burden Reduction Due to:

Short Statement: The revised burden requires the submission of additional information under section 1923(j)(1) of the Social Security Act. To ensure the most accurate burden estimate, there are changes to the hours (from 38 - 42 hr per response) and wages based on our review of State submissions under section 1923(j) of the Social Security Act. Additionally, the number of respondents has been corrected from 52 to 51 (all 50 states and the District of Columbia).