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View ICR - OIRA Conclusion

OMB Control No: 0938-0977	ICR Reference No: 202409-0938-020
Status: Active	Previous ICR Reference No: 202008-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Retiree Drug Subsidy Payment Request Instructions (CMS-10170)
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: 12/13/2024
	Date Received in OIRA: 09/23/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2027	36 Months From Approved	12/31/2024
Responses	1,245	0	2,159
Time Burden (Hours)	187,995	0	326,009
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	1,245	2,159	-914
Annual Time Burden (Hours)	187,995	326,009	-138,014
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 total burden is adjusted from 326,009 hr to 187,995 hr due to a reduction in RDS sponsor enrollment.

Annual Cost to Federal Government: $10,486,868

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. Yes

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. Yes

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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