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: 0938-1051	ICR Reference No: 200809-0938-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Advantage Disclosure Requirements referenced in 42 CFR 422.111(d)(2)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/25/2008
	Date Received in OIRA: 09/04/2008
Terms of Clearance: This ICR is approved consistent with the understanding that the reporting requirements are not duplicated in 0938-0753. CMS agrees to adjust the burden estimates, supporting statements, and information collection materials in 0938-0753 accordingly. Because this collection appears to require adjustments on an annual basis, this collection is approved for 12 months.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2009	36 Months From Approved
Responses	670	0	0
Time Burden (Hours)	8,040	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	670	670
Annual Time Burden (Hours)	8,040	8,040
Annual Cost Burden (Dollars)	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: No

Burden Reduction Due to:

Short Statement: New collection requirements for 422.111(d)(2)-disclosure requirements for changes to a MA plan. Organizations will use a combined standardized document to notify enrollees of plan changes for the upcoming year.

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