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View ICR - OIRA Conclusion

OMB Control No: 0938-0202	ICR Reference No: 202408-0938-039
Status: Active	Previous ICR Reference No: 202012-0938-018
Agency/Subagency: HHS/CMS	Agency Tracking No: CM
Title: Home Office Cost Statement (CMS-287-22)
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: 10/30/2024
	Date Received in OIRA: 08/29/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2027	36 Months From Approved	11/30/2024
Responses	1,646	0	1,626
Time Burden (Hours)	767,036	0	757,716
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	1,646	1,626	20
Annual Time Burden (Hours)	767,036	757,716	9,320
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: The changes in burden and cost for the Form CMS-287-22 result from an increase in the number of respondents by 20 (from 1,626 in 2020 to 1,646 in 2024).

Annual Cost to Federal Government: $7,184,790

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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