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: 0938-0960	ICR Reference No: 201402-0938-004
Status: Historical Active	Previous ICR Reference No: 200906-0938-014
Agency/Subagency: HHS/CMS	Agency Tracking No: 21416
Title: CMS Real-Time Eligibility Agreement and MDCN Access Request
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/08/2014
	Date Received in OIRA: 02/07/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2017	36 Months From Approved
Responses	1,000	0	0
Time Burden (Hours)	250	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	1,000	-1,000	2,000
Annual Time Burden (Hours)	250	-250	500
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 form has been redesigned. In addition to the redesign, the burden estimate is being reduced in numbers and cost because the application has been in use for eight years and a significant number of providers have already enrolled for the system. Additional applications will be expected but volumes are lowered.

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