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View ICR - OIRA Conclusion

OMB Control No: 0938-0065	ICR Reference No: 202108-0938-005
Status: Historical Active	Previous ICR Reference No: 201805-0938-014
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: (CMS-1856) Outpatient Physical Therapy Speech Pathology Survey Report 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 without change	Conclusion Date: 12/13/2021
	Date Received in OIRA: 08/13/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2024	36 Months From Approved	12/31/2021
Responses	195	0	350
Time Burden (Hours)	49	0	88
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	195	350	-155
Annual Time Burden (Hours)	49	88	-39
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: The burden adjustment results from decrease in the estimated hourly wage of workers completing these forms. We have updated the hourly wage to reflect anticipated cost that is based on data from the Bureau of Labor Statistics National Occupational Employment and Wage Estimates for May, 2020. For form CMS-1856, we are using the average hourly wage of $31.00 per hour for a healthcare support staff (Healthcare Support Occupations). We have adjusted the individual completing this form to be an administrative support person, not a manager. Overall, the adjustments have decreased the cost burden based on these changes and based on our analysis that approximately 195 OPT/OSP providers which completed this form annually (initial and recertification surveys). The respondents decreased from 350 to 195.

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

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