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View ICR - OIRA Conclusion

OMB Control No: 0938-1144	ICR Reference No: 202404-0938-006
Status: Active	Previous ICR Reference No: 202203-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No: OEDA
Title: Application To Be a Qualified Entity to Receive Medicare Data for Performance Measurement / Reapplication / Annual Report Worksheet (CMS-10394)
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: 07/16/2024
	Date Received in OIRA: 04/08/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2027	36 Months From Approved	09/30/2025
Responses	70	0	30
Time Burden (Hours)	5,800	0	3,800
Cost Burden (Dollars)	0	0	0

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
QECP Application, Reapplication, DUA and ARW	CMS-10394, CMS-10394, CMS-10394, CMS-10394, CMS-10394, CMS-10394, CMS-10394, CMS-10394, CMS-10394	, , , , , , , ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	70	30	40
Annual Time Burden (Hours)	5,800	3,800	2,000
Annual Cost Burden (Dollars)	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: The changes to burden reflected in this continuation of 0938-1144 are the result of an increase to accommodate new information collected through the QECP Data Security Audit to address concerns about data security and the storage and uses of the government data made available through the QE Program and the addition of the Public Reporting Submission Form. In addition, the increase in number of responses reflects the inclusion of collection activities previously authorized under OMB 0938-1309 and growth in the number of participants in the QE Program.

Annual Cost to Federal Government: $367,776

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]? Yes

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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