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View ICR - OIRA Conclusion

OMB Control No: 0938-0953	ICR Reference No: 202012-0938-012
Status: Historical Active	Previous ICR Reference No: 201711-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Notice of Provider Non-Coverage (CMS-10123) and Detailed Explanation of Non-Coverage (CMS-10124)
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: 08/12/2021
	Date Received in OIRA: 12/29/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2024	36 Months From Approved	08/31/2021
Responses	5,872,396	0	6,076,944
Time Burden (Hours)	1,142,749	0	1,105,925
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	5,872,396	6,076,944	0	-204,548
Annual Time Burden (Hours)	1,142,749	1,105,925	-164,144	200,968
Annual Cost Burden (Dollars)	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: An increased number of fast appeal requests is responsible for the increase in our estimated burden. Reasons for the increases have been attributed to the increasing numbers of Medicare beneficiaries and enrollees. Also, beneficiaries/enrollees and their families are becoming more knowledgeable about exercising their Medicare rights.

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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