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View ICR - OIRA Conclusion

OMB Control No: 0938-0107	ICR Reference No: 201709-0938-008
Status: Historical Active	Previous ICR Reference No: 201408-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-222-17
Title: Rural Health Clinic Cost Report
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: 05/14/2018
	Date Received in OIRA: 09/29/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2021	36 Months From Approved	04/30/2018
Responses	1,744	0	3,264
Time Burden (Hours)	95,920	0	163,200
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	1,744	3,264	-1,520
Annual Time Burden (Hours)	95,920	163,200	-67,280
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: A decrease in the number of respondents from 3,264 in 2014 to 1,744 in 2017. The significant decrease in respondents is a result of FQHCs no longer completing the Form CMS-222-17 as they now complete Form CMS-224-14. The 1,744 respondents in 2017 represent RHCs only.

Annual Cost to Federal Government: $2,660,000

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. 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: Kayla Williams 410 786-5887 Kayla.Williams@cms.hhs.gov

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