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View ICR - OIRA Conclusion

OMB Control No: 0938-0074	ICR Reference No: 202106-0938-001
Status: Historical Active	Previous ICR Reference No: 201808-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: (CMS-29) Request for Certification as Rural Health Clinic Form and Supporting Regulations
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: 05/18/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/01/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2025	36 Months From Approved	05/31/2022
Responses	5,951	0	5,082
Time Burden (Hours)	1,269	0	801
Cost Burden (Dollars)	900	0	812

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	5,951	5,082	0	869
Annual Time Burden (Hours)	1,269	801	-88	556
Annual Cost Burden (Dollars)	900	812	88	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: As noted in the above table, the total burden hours have increased by 468 hours and the total burden costs have increased by $38,348.67. We attribute this increase to several factors. First, there has been an increase in the number of new RHCs and existing RHCs to be surveyed each year. In the previous PRA package it was estimated that there were 210 new RHCs per year and 1,414 RHCs surveyed per year. This equates to 1,624 responses per year. In the current PRA package, we have estimated that there are 290 new RHCs per year and an average of 1,597 exiting RHCs to be surveyed each year. This equates to 1,887 responses per year. This would also be an increase in the number of responses in the amount of 263. When factored into the burden calculation, this increase in the number of responses results in an increase in the total burden hours and burden costs.

Annual Cost to Federal Government: $35,783

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