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OMB Control No: 0938-1420	ICR Reference No: 202507-0938-027
Status: Received in OIRA	Previous ICR Reference No: 202109-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: CPI - 10765
Title: Pre-Claim Review Demonstration for Inpatient Rehabilitation Facility Services (CMS-10765)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 07/31/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	237,419	0
Time Burden (Hours)	120,317	0
Cost Burden (Dollars)	7,896,556	0

ICR Summary of Burden

	Total Request	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	237,419	57,509	179,910
Annual Time Burden (Hours)	120,317	28,784	91,533
Annual Cost Burden (Dollars)	7,896,556	1,912,749	5,983,807

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: Burden hours have increased due to the change in the number of IRFs which increased from 526 to 536. Overall burden hours increased from 91,533 to 120,317 hours. Costs have also increased as a result of the change in IRFs from $3,144,909 to $4,922,031 for all states in the demonstration.

Annual Cost to Federal Government: $900,000

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: Jamaa Hill 301 492-4190