View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0245	ICR Reference No: 201702-0938-004
Status: Historical Active	Previous ICR Reference No: 201309-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Request for Enrollment in Supplementary Medical Insurance and Supporting Regs in 42 CFR 407.10, 407.11 & 408.40 (CMS-4040)
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 without change	Conclusion Date: 05/12/2017
	Date Received in OIRA: 02/22/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	36 Months From Approved	05/31/2017
Responses	47,200	0	10,000
Time Burden (Hours)	11,800	0	2,500
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	47,200	10,000	37,200
Annual Time Burden (Hours)	11,800	2,500	9,300
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: This 2017 iteration is an Extension that does not propose any program changes. However, based on better data we are adjusting our respondent estimate from 10,000 to 47,200, a change of 37,200. Our 15 minute per response estimate is unchanged.

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