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View ICR - OIRA Conclusion

OMB Control No: 0938-0758	ICR Reference No: 201312-0938-003
Status: Historical Active	Previous ICR Reference No: 201011-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: 21002
Title: Hospice Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/06/2014
	Date Received in OIRA: 12/06/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2017	36 Months From Approved	02/28/2014
Responses	2,751	0	2,303
Time Burden (Hours)	517,188	0	405,328
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	2,751	2,303	0	448
Annual Time Burden (Hours)	517,188	405,328	896	110,964
Annual Cost Burden (Dollars)	0	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: No

Burden Reduction Due to:

Short Statement: The total burden for the new Form CMS-1984-14 is estimated to be 517,188 hours and $10,343,760. This is an increase of 111,860 hours and $2,237,200. The changes to the burden are a result of: o On a per respondent basis, revisions to the MCR to facilitate hospice payment reform resulted in an increase in burden of 10 hours. o On a per respondent basis, incorporating the Form CMS-339 into the revised MCR resulted in an increase in burden of 2 hours for this information collection. (However, the overall burden to the provider decreased by 14 hours as a result of eliminating the paper Form CMS-339, for which the burden was estimated at 16 hours.) o The estimated number of respondents increased by 448 (from 2,303 as of June 21, 2010 to 2,751 as of April 4, 2013).

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