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View ICR - OIRA Conclusion

OMB Control No: 0938-1410	ICR Reference No: 202503-0938-002
Status: Active	Previous ICR Reference No: 202206-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Dual Eligible Special Needs Plan Contract with the State Medicaid Agency (CMS-10796)
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: 03/28/2026
	Date Received in OIRA: 03/28/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2029	36 Months From Approved	03/31/2026
Responses	893	0	525
Time Burden (Hours)	17,403	0	22,432
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	893	525	368
Annual Time Burden (Hours)	17,403	22,432	-5,029
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: Burden has decreased due to the removal of multiple one time burdens that are no longer needed. This included a a one-time burden for each new applicable integrated plan to update its policies, procedures, and the D-SNP contract with the state Medicaid agency to reflect the new integrated organization determination and grievance procedures. The removal also included time/effort associated with State Medicaid agencies implement a one-time update to their systems and Plans implement a one-time update to their systems.

Annual Cost to Federal Government: $146,327

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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