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View ICR - OIRA Conclusion

OMB Control No: 0938-1177	ICR Reference No: 201707-0938-002
Status: Historical Active	Previous ICR Reference No: 201509-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No: 19423
Title: (CMS-10393) Beneficiary and Family Centered Data Collection
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: 02/20/2018
	Date Received in OIRA: 07/06/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved	09/30/2019
Responses	24,970	0	16,010
Time Burden (Hours)	2,899	0	4,003
Cost Burden (Dollars)	31,213	0	20,013

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	24,970	16,010	8,960
Annual Time Burden (Hours)	2,899	4,003	-1,104
Annual Cost Burden (Dollars)	31,213	20,013	11,200

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 revised data collection approach will increase the burden hours from 1,601 to 2,899. The burden from the previous package was not revised in ROCIS when the Supporting Statement was updated due to a passback so ROCIS has 4,003 hours for the previous submittal but it should be 1,601 hours.

Annual Cost to Federal Government: $1,588,862

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Denise King 410 786-1013 Denise.King@cms.hhs.gov

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