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View ICR - OIRA Conclusion

OMB Control No: 0985-0040	ICR Reference No: 201503-0985-001
Status: Historical Active	Previous ICR Reference No: 201006-0938-006
Agency/Subagency: HHS/ACL	Agency Tracking No: 18891
Title: State Health Insurance Assistance Program (SHIP) Client Contact Form, Pubic and Media Activity Form, and Resource Report Form
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: 03/24/2015
	Date Received in OIRA: 03/24/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2016	36 Months From Approved
Responses	2,346,465	0	1,672,454
Time Burden (Hours)	195,642	0	139,475
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	2,346,465	1,672,454	674,011
Annual Time Burden (Hours)	195,642	139,475	56,167
Annual Cost Burden (Dollars)	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 Client Contact form and Public and Media Activity form of the National Performance Reporting (NPR) system contains 10 National Special Use Fields (SUFs) and will need to be expanded to capture the data elements for the Duals Financial Alignment Program. The NPR contractor will create the 20 Special Use Fields and will design the NPR web entry screens and the NPR batch upload protocols to allow for the collection of the designated data elements for Duals. See bottom of page 2 of the CC Form: SUFs being added are 11 - 30.

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