View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0202	ICR Reference No: 201410-0938-012
Status: Historical Active	Previous ICR Reference No: 201106-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Home Office Cost Statement and Supporting Regulations in 42 CFR 413.17 and 413.20 (CMS-287-05)
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: 11/24/2014
	Date Received in OIRA: 10/17/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	36 Months From Approved
Responses	1,686	0	0
Time Burden (Hours)	785,676	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	1,686	145	1,541
Annual Time Burden (Hours)	785,676	67,570	718,106
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: This is a reinstatement without change of the previously approved collection. The burden has been adjusted due to an increase in the number of respondents.

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