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View ICR - OIRA Conclusion

OMB Control No: 0938-0933	ICR Reference No: 201704-0938-005
Status: Historical Active	Previous ICR Reference No: 201402-0938-014
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: 1932 State Plan Amendment Template (CMS-10120)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/21/2017
	Date Received in OIRA: 04/21/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved	06/30/2017
Responses	12	0	15
Time Burden (Hours)	70	0	85
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	12	15	-3
Annual Time Burden (Hours)	70	85	-15
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: Despite the number of revisions made to the document, the burden remains the same. While some questions requiring descriptive responses were added, many were deleted and others were put into simpler “check box” tables and questions. We believe the additional and reduced burden are balanced and result in no net change. Based on more recent data we are adjusting the number of responses from 15/year to 12/year. The result is a burden decrease of -15 hours. As indicated, our per response time estimates are unchanged.

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