View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0977	ICR Reference No: 201702-0938-006
Status: Historical Active	Previous ICR Reference No: 201311-0938-026
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Retiree Drug Subsidy Payment Request Instructions (CMS-10170)
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: 06/28/2017
	Date Received in OIRA: 02/23/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved	06/30/2017
Responses	2,482	0	4,500
Time Burden (Hours)	374,782	0	679,500
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	2,482	4,500	-2,018
Annual Time Burden (Hours)	374,782	679,500	-304,718
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: Miscellaneous Actions

Short Statement: The total burden is adjusted from 679,500 hr to 374,782 hr due to a reduction in RDS sponsor enrollment.

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