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View ICR - OIRA Conclusion

OMB Control No: 0938-0080	ICR Reference No: 201707-0938-008
Status: Historical Active	Previous ICR Reference No: 201311-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Application for Hospital Insurance Benefits Medicare for Individuals with End Stage Renal Disease and Supporting Regulations in 42 CFR 406.7 and 406.13 (CMS-43)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/13/2018
	Date Received in OIRA: 07/19/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved
Responses	25,000	0	0
Time Burden (Hours)	10,400	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	25,000	-35,000	60,000
Annual Time Burden (Hours)	10,400	-14,560	24,960
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: We propose to adjust our respondent burden (from 60,000 respondents to 25,000 respondents) based on improved methods of estimating the number of respondents. The Medicare Beneficiary Database (MBD) provides more accurate data than was previously used in 2013. The data for the 12 month period of January-December 2016 was used to determine the annual number of responses. This information was used to determine that there was a significant decrease in responses compared to 2013. In this regard, our time estimate has decreased by -14,560 hours. We now estimate an annual burden of 10,400 hours.

Annual Cost to Federal Government: $534,475

Does this IC contain surveys, censuses, or employ statistical methods? No

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. Yes

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. Yes

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: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov

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