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OMB Control No: 0938-0969	ICR Reference No: 202509-0938-008
Status: Received in OIRA	Previous ICR Reference No: 202110-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: CPI
Title: Medicare Fee-for-Service Early Review of Medical Records (CMS-10417)
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: 09/04/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2025
Responses	489,871	485,632
Time Burden (Hours)	244,936	242,816
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	489,871	485,632	4,239
Annual Time Burden (Hours)	244,936	242,816	2,120
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The change in burden is due to an increase in form usage.

Annual Cost to Federal Government: $84,000,000

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