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View ICR - OIRA Conclusion

OMB Control No: 0938-1042	ICR Reference No: 202304-0938-007
Status: Active	Previous ICR Reference No: 202103-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: HCPCS Modification to Code Set Form (CMS-10224)
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: 07/19/2023
	Date Received in OIRA: 04/12/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2026	36 Months From Approved	07/31/2023
Responses	250	0	150
Time Burden (Hours)	2,500	0	1,500
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	250	150	100
Annual Time Burden (Hours)	2,500	1,500	1,000
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 applications being filed have increased from 150 to 250 annually for this PRA package. Therefore, we have calculated the burden as follows: 250 responses x 10 hours per response = 2500 burden hours (annual). This resulted in an increase of 1,000 hours from the last approved burden.

Annual Cost to Federal Government: $523,078

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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