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View ICR - OIRA Conclusion

OMB Control No: 0938-0778	ICR Reference No: 201910-0938-007
Status: Historical Active	Previous ICR Reference No: 201607-0938-014
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Medicare Health Plan Appeals and Grievance Data Collection and Reporting Requirements, Data Disclosure Requirements under section 422.111 (CMS-R-282)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/07/2020
	Date Received in OIRA: 11/25/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2023	36 Months From Approved	07/31/2020
Responses	59,133	0	56,782
Time Burden (Hours)	5,405	0	5,906
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	59,133	56,782	2,351
Annual Time Burden (Hours)	5,405	5,906	-501
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: Yes

Burden Reduction Due to: Cutting Redundancy

Short Statement: Burden reduction has occurred due to a change in the collection and reporting periods to align with the Part C Reporting Requirements (OMB 0938-1054). There was also a change in the number of items reported (reduced from nineteen to six). Lastly, we removed the data related to expedited appeals, IRE (level 2 appeals), and withdrawals. This reduces the total number of pages of the form by 50% (previously six pages and is now three pages).

Annual Cost to Federal Government: $0

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? No

Agency Contact: Stephan McKenzie 410 786-1943 stephan.mckenzie@cms.hhs.gov

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