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View ICR - OIRA Conclusion

OMB Control No: 0938-0679	ICR Reference No: 201605-0938-012
Status: Historical Active	Previous ICR Reference No: 201410-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: 19199
Title: Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation
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: 02/17/2017
	Date Received in OIRA: 05/12/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2020	36 Months From Approved	02/28/2017
Responses	2,094,000	0	462,000
Time Burden (Hours)	418,800	0	92,400
Cost Burden (Dollars)	0	0	0

Authorizing Statute(s): US Code: 42 USC 1395j(5) Name of Law: Special Payment Rules for Particular Items and Services
   US Code: 42 USC 1395m(j)(2) Name of Law: Certificates of Medical Necessity
   US Code: 42 USC 1395m(j)(2)(A)(iii) Name of Law: Penalty
   US Code: 42 USC 1395y(a)(1)(A) Name of Law: Items or Services Specifically Excluded
   US Code: 42 USC 1395y(a) Name of Law: Items or Services Specifically Excluded
   US Code: 42 USC 1395x(n) Name of Law: Durable medical equipment
   US Code: 42 USC 1395l(e) Name of Law: Information for Determination of Amounts Due

Citations for New Statutory Requirements: None

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	2,094,000	462,000	1,632,000
Annual Time Burden (Hours)	418,800	92,400	326,400
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: CMS is increasing the burden from 92,163 hours to 418,800 hours to account for merging CMS-484, into this collection; therefore there is a total burden hour increase of 326,400.

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