View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0769	ICR Reference No: 201309-0938-016
Status: Historical Active	Previous ICR Reference No: 200903-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: 20495
Title: Request for Retirement Benefit Information
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/21/2014
	Date Received in OIRA: 09/13/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2017	36 Months From Approved
Responses	500	0	0
Time Burden (Hours)	125	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	500	-1,000	1,500
Annual Time Burden (Hours)	125	-250	375
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: Our cost estimate has been adjusted as it decreased from $5,626 to $1,875. This is a result of decreased need and usage for this form as the number of state and local government entities providing pension retirement plans is decreasing. Specifically, in 2009 we estimated 1,500 respondents; in this 2013 package we adjust that estimate to 500 respondents. Please note that the time per response has not changed.

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