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View ICR - OIRA Conclusion

OMB Control No: 0938-1049	ICR Reference No: 202003-0938-001
Status: Historical Active	Previous ICR Reference No: 201612-0938-017
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b) (CMS-10242)
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 without change	Conclusion Date: 07/07/2020
	Date Received in OIRA: 03/03/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2023	36 Months From Approved	07/31/2020
Responses	13,318,440	0	14,155,617
Time Burden (Hours)	1,110,757	0	1,180,578
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	13,318,440	14,155,617	-837,177
Annual Time Burden (Hours)	1,110,757	1,180,578	-69,821
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 number of Medicare-enrolled ambulance suppliers decreased from 10,402 to 10,229. The total estimated number of ambulance transports for Part B-paid claims in 2018 was 13,318,440. This number represents a 5.91% decrease in the number of Part B-paid ambulance transport claims from 2015. In light of these facts, we have adjusted the annual time and cost burden estimates accordingly. The total number of burden hours decreased from 1,180,578 to 1,110,757.

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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