View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0758	ICR Reference No: 202106-0938-004
Status: Historical Active	Previous ICR Reference No: 201707-0938-014
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-1984-14
Title: Hospice FacilityCost Report
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: 11/03/2021
	Date Received in OIRA: 06/10/2021
Terms of Clearance: CMS should improve their monitoring of expiring information collections to avoid unnecessary reinstatement requests.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2024	36 Months From Approved
Responses	4,379	0	0
Time Burden (Hours)	823,252	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	4,379	834	3,545
Annual Time Burden (Hours)	823,252	156,792	666,460
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: We determined that the revisions to Worksheets A, B, and B-1, resulted in no change to the burden. The change in hourly burden was due to an increased number of respondents by 834 (from 3,545 in 2017 to 4,379 in 2021). This increase in respondents has increased the hourly burden to 823,252.

Annual Cost to Federal Government: $700,850

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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