View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-1177	ICR Reference No: 202010-0938-001
Status: Historical Active	Previous ICR Reference No: 201707-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Beneficiary and Family Centered Data Collection (CMS-10393)
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: 08/17/2021
	Date Received in OIRA: 10/01/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2024	36 Months From Approved	08/31/2021
Responses	8,700	0	24,970
Time Burden (Hours)	2,175	0	2,899
Cost Burden (Dollars)	30,320	0	31,213

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	8,700	24,970	-400	-15,870
Annual Time Burden (Hours)	2,175	2,899	-16	-708
Annual Cost Burden (Dollars)	30,320	31,213	18,945	-19,838

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Total estimated burden for this request represents a decrease in burden hours from 2,899 (approach approved in February 2018 as OMB NO. 0938-1177) to 2,175 and costs. When the contract was competed in 2020, the decision was made to remove the Direct Follow-up survey and the General Web survey, because fewer beneficiaries responded through those two modes of data collection. The decision to remove the administration of these surveys was reflected in the determination letter the QIOs send to beneficiaries.

Annual Cost to Federal Government: $1,767,387

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: Denise King 410 786-1013 Denise.King@cms.hhs.gov

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