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OMB Control No: 0938-1360	ICR Reference No: 202509-0938-030
Status: Received in OIRA	Previous ICR Reference No: 202206-0938-020
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: Electronic Visit Verification (EVV) Compliance Survey (CMS-10680)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 09/30/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2025
Responses	20	168
Time Burden (Hours)	20	252
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	20	168	-148
Annual Time Burden (Hours)	20	252	-232
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: In this 2025 iteration we are adjusting our active burden estimates since all states and territories have completed their initial survey responses for PCS and HHCS. In addition, fewer survey updates are estimated since all states and territories have completed their initial survey response for PCS and HHCS, with 53 of 56 states having fully achieved compliance for PCS and 48 of 56 states having fully achieved compliance for HHCS. Wages and costs have also been updated to reflect the most recent BLS data. Overall, we estimate 46 fewer respondents, 148 fewer responses, 232 fewer hours, and minus $17,285. We are not revising any of our active survey instruments and instructions.

Annual Cost to Federal Government: $3,715

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: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov