View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-1196	ICR Reference No: 202409-0938-006
Status: Active	Previous ICR Reference No: 202111-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Home Health Change of Care Notice (HHCCN) (CMS-10280)
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: 11/12/2024
	Date Received in OIRA: 09/06/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2027	36 Months From Approved	12/31/2024
Responses	19,004,850	0	12,385,108
Time Burden (Hours)	1,265,723	0	824,848
Cost Burden (Dollars)	0	0	0

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

IC Title	Form No.	Form Name
Home Health Change of Care Notice (HHCCN)	CMS-10280, CMS-10280, CMS-10280, CMS-10280, CMS-10280	, , , ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	19,004,850	12,385,108	6,619,742
Annual Time Burden (Hours)	1,265,723	824,848	440,875
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 annual hour burden associated with this collection is estimated to be 1,265,723 hours. The annual hour burden associated in the prior PRA submission for this collection was 824,848 hours which increases the annual hour burden by 440,875. The increase in the burden estimates is likely due to an increase in the annual number of home health episodes (from 6,047,416 to 9,279,712) which would cause an increase in the number of HHCCNs issued annually per respondent (from 12,385,108 to 19,004,850).

Annual Cost to Federal Government: $1,537

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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