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View ICR - OIRA Conclusion

OMB Control No: 0938-1347	ICR Reference No: 201912-0938-014
Status: Historical Active	Previous ICR Reference No: 201902-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: PRA for the Add-On Payments for New Medical Services and Technologies Policy(CMS-10638)
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: 11/23/2020
	Date Received in OIRA: 12/19/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2023	36 Months From Approved	12/31/2020
Responses	62	0	32
Time Burden (Hours)	1,655	0	1,280
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	62	32	30
Annual Time Burden (Hours)	1,655	1,280	375
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 have increased the estimated annual number of total respondents from 32 to 62, based on the proposed alternative new technology add-on payment pathway for certain devices. All time and cost burdens have been adjusted accordingly.

Annual Cost to Federal Government: $175,696

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

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