View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-0971	ICR Reference No: 202410-0938-003
Status: Active	Previous ICR Reference No: 202009-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: (CMS-10116) Medicare Program: Conditions of Payment of Power Mobility Devices, Including Power Wheelchairs and Power-Operated Vehicles
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/16/2024
	Date Received in OIRA: 10/09/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2027	36 Months From Approved
Responses	46,990	0	0
Time Burden (Hours)	10,964	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses	46,990	-8,710	55,700
Annual Time Burden (Hours)	10,964	-2,033	12,997
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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Estimates of burden associated with regulation CMS-3017-F presented in this PRA package differ from those of previous PRA packages due to differences in the estimated total number claims submitted for payment as well as changes in reimbursement rates. For example, the previous CMS calculation estimated 55,700 submitted claims in 2020. For this package, CMS estimates that 46,990 claims will be submitted for payment in CY2024, which translates into a reduction of 2,033 hours from the prior estimates (the burden hours have decreased from 12,997 to 10,964).

Annual Cost to Federal Government: $113

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: Denise King 410 786-1013 Denise.King@cms.hhs.gov

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.