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View ICR - OIRA Conclusion

OMB Control No: 0938-1049	ICR Reference No: 202304-0938-006
Status: Active	Previous ICR Reference No: 202003-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b) (CMS-10242)
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: 06/20/2023
	Date Received in OIRA: 04/12/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2026	36 Months From Approved	07/31/2023
Responses	10,954,288	0	13,318,440
Time Burden (Hours)	912,492	0	1,110,757
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	10,954,288	13,318,440	-2,364,152
Annual Time Burden (Hours)	912,492	1,110,757	-198,265
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 number of Medicare-enrolled ambulance suppliers increased from 10,229 to 10,233. The total estimated number of ambulance transports for Part B-paid claims in 2021 was 10,954,288. This number represents a 17.75% decrease in the number of Part B-paid ambulance transport claims from 2018. The total number of burden hours decreased from 1,110,757 to 912,492

Annual Cost to Federal Government: $8,500

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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