View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-1197	ICR Reference No: 201602-0938-005
Status: Historical Active	Previous ICR Reference No: 201211-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-1500(02-12)
Title: Health Insurance Common Claims Form and Supporting Regulations at 42 CFR Part 424, Subpart C
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 with change	Conclusion Date: 03/29/2017
	Date Received in OIRA: 02/25/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved	03/31/2017
Responses	1,003,431,991	0	988,005,045
Time Burden (Hours)	19,818,656	0	21,418,336
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	1,003,431,991	988,005,045	15,426,946
Annual Time Burden (Hours)	19,818,656	21,418,336	-1,599,680
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: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: The 2012 numbers reflect 988,005,045 Reponses and Burden Hours of 21,418,336 and 2016 numbers are for 1,003,431,995 responses and Burden hours of 19,818,656. The total reported Burden hours reported for 2015 decreased from the previous reporting period of 2012 due to the number of electronic claim submissions increased. 2012 reflected: 988,005,045 total number of claims with a total Burden Hours of 21,418,336 2015 reflected: 1,003,431,995 total number of claims with a total Burden Hours of 19,818,656 The total ‘Cost of Forms and Mailing of Forms’ also decreased in 2015. 2012: Total number of claims: 988,005,045 total annual Cost of Forms and Mailing: $90,711,997 2015: Total number of claims: 1,003,431,995 total annual Cost of Forms and Mailing: $87,724,973

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