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View ICR - OIRA Conclusion

OMB Control No: 0938-0266	ICR Reference No: 201106-0938-018
Status: Historical Active	Previous ICR Reference No: 200802-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Ambulatory Surgical Center (ASC) Health Insurance Benefits Agreement Form, Request for Certification, Survey Report (CMS-377, 378, 370)
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: 09/05/2011
	Date Received in OIRA: 06/21/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2014	36 Months From Approved	09/30/2011
Responses	2,090	0	5,123
Time Burden (Hours)	647	0	2,787
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	2,090	5,123	-3,000	-33
Annual Time Burden (Hours)	647	2,787	-2,000	-140
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: Cutting Redundancy

Short Statement: The reduction in burden is based on the program change regarding the discontinuance of Form CMS-378. The burden is also adjusted to account for the increased number of ASCs. The discontinuance of Form CMS-378 more than offsets burdens associated with growth in the number of ASCs.

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