View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0626	ICR Reference No: 201912-0938-021
Status: Historical Active	Previous ICR Reference No: 201609-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: CPI - 588
Title: Electronic Funds Transfer Authorization Agreement (CMS-588)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/01/2020
	Date Received in OIRA: 01/27/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2023	36 Months From Approved	11/30/2020
Responses	115,833	0	45,807
Time Burden (Hours)	57,917	0	22,906
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	115,833	45,807	70,026
Annual Time Burden (Hours)	57,917	22,906	35,011
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: The total individual hour burden associated with this information collection is approximately 0.5 hours (30 minutes) per EFT form. The burden increased based on the number of respondents. The difference in respondents is 70,026 (115,833 minus 45,807). The burden hours increased 70,026 hours (57,917 hours minus 22,906 hours). The burden hour increase is due to the significantly higher number of respondents than reported in the prior revision. Previously, it was reported that 45,807 respondents completed the EFT authorization, a number also obtained from PECOS. This shows a clear increase in the number of respondents, and therefore the number of burden hours. The prior revision’s respondents were also exact processing figures from the PECOS system.

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. 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. Yes

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: Jamaa Hill 301 492-4190

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