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View ICR - OIRA Conclusion

OMB Control No: 0938-0251	ICR Reference No: 201402-0938-013
Status: Historical Active	Previous ICR Reference No: 201012-0938-021
Agency/Subagency: HHS/CMS	Agency Tracking No: 21473
Title: Application for Hospital Insurance
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/03/2014
	Date Received in OIRA: 02/26/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved	07/31/2014
Responses	50,000	0	50,000
Time Burden (Hours)	12,500	0	12,495
Cost Burden (Dollars)	0	0	0

Authorizing Statute(s): US Code: 42 USC 1395i-2a Name of Law: Hospital Insurance Benefits for Disabled Individuals Who Have Exhausted Other Entitilements
   US Code: 42 USC 426 Name of Law: Entitlement to Hospital Insurance Benefits
   US Code: 42 USC 1935i-2 Name of Law: Hospital Insurance Benefits for Uninsured Elderly Individuals not Otherwise Eligible
   PL: Pub.L. 42 - 406 10 Name of Law: Hospital Insurance Eligibility and Entitlement
   US Code: 42 USC 427 Name of Law: Transitional Insured Status
   PL: Pub.L. 42 - 406 11 Name of Law: Individual age 65 or over who is not eligible as a social security or railroad retirement benefits
   PL: Pub.L. 42 - 406 20 Name of Law: Premium Hospital Insurance - Basic Requirements
   PL: Pub.L. 42 - 406 6 Name of Law: Application or enrollment for hospital insurance
   PL: Pub.L. 42 - 406 7 Name of Law: Forms to apply for entitlement under Medicare Part A

Citations for New Statutory Requirements: None

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	50,000	50,000	0
Annual Time Burden (Hours)	12,500	12,495	5
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 changes in burden are to correct miscalculation in the response time from the prior submission. The prior package indicated that 15 minutes was 0.2499 minutes, however, the proper calculation should be 0.25 minutes. When multiplied by the number of forms (50,000), there was an increase in 5 burden hours annually. This slight increase in burden hours when calculated to determine the annual cost burden resulted in an increase of $136.55. Since the last submission in 2010, there have been no increases in printing costs or the hourly rate of payment for the SSA representative collecting and processing the information.

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