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: 0938-0753	ICR Reference No: 202006-0938-010
Status: Historical Active	Previous ICR Reference No: 201905-0938-018
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Medicare Advantage Program and Supporting Regulations (CMS-R-267)
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: 10/21/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/10/2020
Terms of Clearance: In the next submission, CMS will evaluate whether the 9 or fewer exemption under 5 CFR 1320.3(c)(4) was properly applied to each of the provisions listed under section 12B of the current (Oct 2021) supporting statement. If it was not applied properly, CMS will correct the supporting statement within 18 months from the date of this TOC. While a provision may have 9 or fewer respondents annually, the provision may still be subject to the PRA if the respondents represent the majority or all of an industry or sector. Also in the next submission, CMS shall seek comment on an extension for the entire package.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2023	36 Months From Approved	12/31/2021
Responses	12,138,998	0	35,597,180
Time Burden (Hours)	2,677,853	0	9,466,233
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	12,138,998	35,597,180	-23,458,182
Annual Time Burden (Hours)	2,677,853	9,466,233	-6,788,380
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: In this 2020 collection of information request the standard (“long”) model enrollment form to elect an MA plan established at 42 CFR 422.50 and 422.60 has been extracted into its own stand-alone information collection request (CMS-10718; OMB control number: 0938-1378). This iteration also requests approval of our new minimum criteria for dual eligible special needs plans (D-SNPs) to integrate Medicare and Medicaid benefits detailed in Section 50311(b) of the Bipartisan Budget Act of 2018 and set forth in our April 16, 2019 (84 FR 15680) final rule CMS-4185-F (RIN 0938-AT59) for CY2020 and 2021. The integration requirements improve care coordination, quality of care, and beneficiary satisfaction while reducing administrative burden. Lastly, this collection request subsumes revisions that are set out under our June 2, 2020 (85 FR 33796) final rule (CMS-4190-F; RIN 0938-AT97). Overall, the revisions reduce our burden estimates by minus 6,788,380 hours.

Annual Cost to Federal Government: $12,650,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. 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? No

Agency Contact: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov