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View ICR - OIRA Conclusion

OMB Control No: 0938-0787	ICR Reference No: 202412-0938-006
Status: Active	Previous ICR Reference No: 202305-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Request for Employment Information (CMS-R-297/CMS-L564)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/07/2025
	Date Received in OIRA: 12/10/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2028	36 Months From Approved
Responses	1,189,996	0	0
Time Burden (Hours)	297,499	0	0
Cost Burden (Dollars)	0	0	0

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

IC Title	Form No.	Form Name
Request for Employment Information	CMS-R-297 (CMS-L564), CMS-R-297 (CMS-L564), CMS-R-297 (CMS-L564) , CMS-R-297 (CMS-L564), CMS-R-297 (CMS-L564)	, , , ,

ICR Summary of Burden

	Total Approved	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,189,996	513,470	676,526
Annual Time Burden (Hours)	297,499	128,367	169,132
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: CMS’ burden estimates have increased due to improved enrollment data provided by the Social Security Administration’s Office of Income Security Programs. The data provided an increase of 579,998, a significant increase from the 2023 approved submission. CMS used internal estimates for the 2023 submission. The estimate for the current submission is based on the CMS-L564 volume for the 2023 calendar year.

Annual Cost to Federal Government: $1,416,576

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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