View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-0676	ICR Reference No: 202003-0938-011
Status: Historical Active	Previous ICR Reference No: 201704-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: Reconciliation of State Invoice (ROSI) (CMS-304) and Prior Quarter Adjustment Statement (PQRS) (CMS-304a)
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: 06/23/2020
	Date Received in OIRA: 03/31/2020
Terms of Clearance: CMS shall display the OMB control number and expiration. In any future revision, extension, or reinstatement request for this collection, CMS shall detail how it is complying with the requirements at 5 CFR 1320.8(b)(3) for this collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2023	36 Months From Approved	06/30/2020
Responses	5,020	0	4,468
Time Burden (Hours)	227,416	0	202,384
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	5,020	4,468	552
Annual Time Burden (Hours)	227,416	202,384	25,032
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: In this 2020 iteration our total time estimates have increased by 25,032 hours due to an increase in the number of respondents (manufacturer participation increased from 657 to 738). Although we are proposing minor updates to the punctuation, field names, and data definitions on forms CMS-304 and -304a, the changes are intended to align the forms with CMS-367 (OMB 0938-0578) and CMS-368/-R-144 (OMB 0938-0582). Our per response time estimates remain unchanged. Lastly, our cost estimates have increased by $1,931,374 as a result of the increased number of manufacturers and the use of more recent BLS wage data.

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]? Yes

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: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov

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