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: 0938-0935	ICR Reference No: 201509-0938-013
Status: Historical Active	Previous ICR Reference No: 201410-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Advantage Application - Part C and 1876 Cost Plan Expansion Application Regulations under 42 CFR 422 (Subpart K) & 417.400 (CMS-10237)
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: 01/21/2016
	Date Received in OIRA: 09/30/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2019	36 Months From Approved	11/30/2017
Responses	500	0	566
Time Burden (Hours)	18,043	0	22,625
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	500	566	-66
Annual Time Burden (Hours)	18,043	22,625	-4,582
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: We have adjusted our cost estimates by using the most recent BLS wage estimates. The reduction of 699 hr in annual burden hours (22,625 hr - 21,926 hr = -699 hr) from CY 2016 to CY 2017 is attributed to the reduction in the estimated hours to complete both SNP with MA and SNP with SAE applications. The estimated hours for completion of a SNP application was 42 hours in CY2016 which was reduced to 39 hours in CY2017. Note the projected number of SNP applications remained unchanged from CY2016 to CY2017. There is a 3 hr increase in burden from the MA initial application and a 3 hr decrease for the SNP Proposal for CY2017. Thus, the increase and decrease in burden hours cancel each other.

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.