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View ICR - OIRA Conclusion

OMB Control No: 0938-0626	ICR Reference No: 202305-0938-005
Status: Active	Previous ICR Reference No: 201912-0938-021
Agency/Subagency: HHS/CMS	Agency Tracking No: CPI - 588
Title: Electronic Funds Transfer Authorization Agreement (CMS-588)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/13/2023
	Date Received in OIRA: 05/15/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2026	36 Months From Approved	12/31/2023
Responses	82,807	0	115,833
Time Burden (Hours)	56,037	0	57,917
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	82,807	115,833	-33,026
Annual Time Burden (Hours)	56,037	57,917	-1,880
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 increased by +1,880 hours (from 57,917 to 56,037 hours). According to the PECOS system, there was a decrease of -33,026 respondents (115,833 to 82,807). In addition, the time per response increased by +.08 hours which offset the total burden change.

Annual Cost to Federal Government: $1,521

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. Yes

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. Yes

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: Jamaa Hill 301 492-4190

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