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View ICR - OIRA Conclusion

OMB Control No: 0938-1258	ICR Reference No: 202405-0938-023
Status: Active	Previous ICR Reference No: 202212-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO - 10454
Title: Disclosure of State Rating Requirements Notice (CMS-10454)
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: 07/24/2024
	Date Received in OIRA: 06/10/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2027	36 Months From Approved	08/31/2024
Responses	3	0	3
Time Burden (Hours)	7	0	17
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	3	3	0
Annual Time Burden (Hours)	7	17	-10
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: States have already incurred the one-time costs of conducting necessary studies and submitting information on their rating factors to CMS. Therefore, total burden for reporting decreased by 9.67 hours (from 17 hours to 7.33 hours) because states will only incur the burden of reporting changes to their rating factors.

Annual Cost to Federal Government: $401

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: Jamaa Hill 301 492-4190

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