View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-1347	ICR Reference No: 201902-0938-007
Status: Historical Active	Previous ICR Reference No: 201706-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-10638
Title: PRA for the Add-On Payments for New Medical Services and Technologies Policy
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/07/2019
	Date Received in OIRA: 02/07/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2020	12/31/2020	12/31/2020
Responses	32	0	15
Time Burden (Hours)	1,280	0	600
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	32	15	17
Annual Time Burden (Hours)	1,280	600	680
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: This is a non-substantive change request. We are adjusting the estimated annual number of respondents due to larger than expected volume. No other changes have been made to the ICR.

Annual Cost to Federal Government: $66,720

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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