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View ICR - OIRA Conclusion

OMB Control No: 0938-0107	ICR Reference No: 202112-0938-011
Status: Historical Active	Previous ICR Reference No: 201709-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: Independent Rural Health Clinic Cost Report (CMS-222-17)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/23/2022
	Date Received in OIRA: 01/06/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2025	36 Months From Approved
Responses	1,724	0	0
Time Burden (Hours)	94,820	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	1,724	-20	1,744
Annual Time Burden (Hours)	94,820	-1,100	95,920
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: Burden has decreased due to a decrease in the number of respondents from 1,744 in 2017 to 1,724 in 2021 as a result of voluntary and involuntary terminations and the option for RHC providers to file consolidated cost reports.

Annual Cost to Federal Government: $2,630,000

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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