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OMB Control No: 0938-0236	ICR Reference No: 202508-0938-016
Status: Received in OIRA	Previous ICR Reference No: 202205-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: Independent Renal Dialysis Facility Cost Report (CMS-265-11)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 08/19/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2025
Responses	7,329	7,541
Time Burden (Hours)	483,714	497,706
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	7,329	7,541	-212
Annual Time Burden (Hours)	483,714	497,706	-13,992
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: The decrease in burden is due to a decrease in the number of respondents.

Annual Cost to Federal Government: $8,312,097

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: Malcolm Wilson 667 414-0087 malcolm.wilson@cms.hhs.gov