View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-1179	ICR Reference No: 201509-0938-008
Status: Historical Active	Previous ICR Reference No: 201206-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Enrollment Application- Reassignment of Medicare Benefits (CMS-855R)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/15/2016
	Date Received in OIRA: 09/17/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2019	36 Months From Approved	04/30/2016
Responses	379,619	0	200,000
Time Burden (Hours)	94,905	0	50,000
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	379,619	200,000	179,619
Annual Time Burden (Hours)	94,905	50,000	44,905
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 currently approved total annual hour burden for the respondents for the CMS 855R is 50,000 hours. Due to better reporting methods and more accurate data collection via PECOS, CMS is seeking approval of new burden estimates based on current data collection information. CMS estimates the new total burden hours for this information collection to be 83,936 hours to establish a reassignment and 10,969 hours to terminate a reassignment, a total increase of 44,905 hours.

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