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View ICR - OIRA Conclusion

OMB Control No: 0938-0667	ICR Reference No: 202006-0938-016
Status: Historical Active	Previous ICR Reference No: 201701-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: Examination and Treatment for Emergency Medical Conditions and Women in Labor (EMTALA), 42 CFR 482.12, 488.18, 489.20, and 489.24 (R-142)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/17/2020
	Date Received in OIRA: 07/06/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2023	36 Months From Approved
Responses	5,291	0	0
Time Burden (Hours)	5,291	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	5,291	419	4,872
Annual Time Burden (Hours)	5,291	419	4,872
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: Burden increase to 5,291 from the previously estimated 4,872 Medicare-participating hospitals is due to the specific requirements currently applying to additional Medicare-participating hospitals, including hospitals paid under the Inpatient Prospective Payment System, critical access hospitals, children’s hospitals, psychiatric hospitals, and 6 hospitals located in the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa paid in accordance with the Tax Equity and Fiscal Responsibility Act of 1982.

Annual Cost to Federal Government: $2,437,100

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. 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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