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View ICR - OIRA Conclusion

OMB Control No: 0938-0953	ICR Reference No: 202407-0938-011
Status: Active	Previous ICR Reference No: 202012-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Notice of Provider Non-Coverage (CMS-10123) and Detailed Explanation of Non-Coverage (CMS-10124) (CMS-10123/10124)
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: 11/08/2024
	Date Received in OIRA: 08/07/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2027	36 Months From Approved	11/30/2024
Responses	21,369,755	0	5,872,396
Time Burden (Hours)	3,972,305	0	1,142,749
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	21,369,755	5,872,396	15,497,359
Annual Time Burden (Hours)	3,972,305	1,142,749	2,829,556
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: An increased number of QIO appeal requests is responsible for the increase in our estimated burden for the DENC. Reasons for the increases have been attributed to the increasing numbers of Medicare beneficiaries and enrollees. The estimated burden for the DENC is expected to increase once 4205-F becomes effective January 1, 2025. CMS estimate that approximately 8,059 fast track appeals will be shifted from MA plans to the QIO (0.025 × 322,379), and thus, a DENC will be required for these appeals. This will raise the total annual burden estimate for the DENC to 472,305 hours (75 min/60 x 377,844 (369,755+8,089) DENCs beginning January 1, 2025.

Annual Cost to Federal Government: $1,588

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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