View Information Collection Request (ICR) Package

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: 0938-0958	ICR Reference No: 200807-0938-002
Status: Historical Active	Previous ICR Reference No: 200506-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Monthly State File of Medicaid/Medicare Dual Eligible Enrollees (CMS-10143)
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: 11/24/2008
	Date Received in OIRA: 07/10/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2011	36 Months From Approved	11/30/2008
Responses	612	0	612
Time Burden (Hours)	6,120	0	10,710
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	612	612	0
Annual Time Burden (Hours)	6,120	10,710	-4,590
Annual Cost Burden (Dollars)	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 monthly Medicaid/Medicare dual eligible file burden hours represent the routine monthly burden hours after the initial start-up burden reflected in the OMB approval of August 2005. The burden estimates of 10,710 were based on start-up efforts. The revised estimates of 6,120 indicate a maintenance level of effort, without change.

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