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View ICR - OIRA Conclusion

OMB Control No: 0938-1065	ICR Reference No: 201801-0938-006
Status: Historical Active	Previous ICR Reference No: 201411-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: State Collection and Reporting of Dental Provider and Benefit Package Information on the Insure Kids Now! Website and Hotline (CMS-10291)
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: 06/19/2018
	Date Received in OIRA: 01/23/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2021	36 Months From Approved	06/30/2018
Responses	255	0	255
Time Burden (Hours)	11,781	0	10,838
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	255	255	0
Annual Time Burden (Hours)	11,781	10,838	943
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The burden was increased by 943 hours (18.5 hr x 51 states). The 18 hr per response increase consists of: * -2 hours per year due to making three fields in the provider collection (Services_Mobility; Sedation; and Services_Intellectual_Disability) optional, because it was determined that this information is not readily available to states. * +20 hours per year due to updating provider collection data validation rules to require States to indicate a Program Type (Medicaid or CHIP), and to reject submissions where five percent or more of records are duplicated. * +0.5 hours per year due to updating the benefits collection to include three new fields, including two diagnostic services (Oral health screening or assessment, Assessment of risk for tooth decay), and one treatment service (Anti-microbial treatments that stop decay from spreading).

Annual Cost to Federal Government: $373,237

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

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