View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-0746	ICR Reference No: 202404-0938-003
Status: Active	Previous ICR Reference No: 202309-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: Medicaid Disproportionate Share Hospital Annual Reporting (CMS-R-266)
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: 04/26/2024
	Date Received in OIRA: 04/03/2024
Terms of Clearance: OMB is approving this information collection request associated with rulemaking (RIN 0938-AV00) for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2027	36 Months From Approved	11/30/2026
Responses	50	0	51
Time Burden (Hours)	2,250	0	2,142
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	50	51	0	-1
Annual Time Burden (Hours)	2,250	2,142	150	-42
Annual Cost Burden (Dollars)	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: CMS-2445-F requires the submission of an additional element of data in an electronic spreadsheet format that is already part of the collection requirement. We estimate the additional data element would take approximately 3 additional hours. In aggregate, the estimated annual burden is 150 hours (50 States x 3 hour). Outside of and unrelated to the final rule we have adjust our active number of respondents from 51 to 50 as Massachusetts is excluded from the estimated number of respondents as it currently does not complete DSH audits because its entire DSH allotment amount is diverted for payments under a section 1115 demonstration project. The District of Columbia is included in our active estimate and remains as is. The change reduces our total time estimate by 2,142 hours (42 hr x 51 States) Active 2,100 hours (42 hr x 50 States) Adjustment minus 42 total hours Combined, this iteration removes one response (from 51 to 50 responses) and increases our time estimate by 108 hours (150 hr - 42 hr).

Annual Cost to Federal Government: $2,826

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: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov

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