View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0938-1444	ICR Reference No: 202512-0938-015
Status: Active	Previous ICR Reference No: 202302-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Annual Notice of Change and Evidence of Coverage for Applicable Integrated Plans in States that Require Integrated Materials (CMS-10824)
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: 05/28/2026
	Date Received in OIRA: 12/16/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2029	36 Months From Approved	06/30/2026
Responses	109	0	47
Time Burden (Hours)	1,308	0	564
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	109	47	62
Annual Time Burden (Hours)	1,308	564	744
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: No

Burden Reduction Due to:

Short Statement: Burden has increased due to an increase of 109 AIPs that will employ these models, which more than doubles our previous estimate. The number of AIPs has increased since 2023, when this package was last published. Because the number of AIPs has increased, the burden for completing the requirements in this package has increased in equal measure, by over 100 percent. CMS has also made small modifications to the models, however, these modifications have not affected burden, as many are non-substantive, and others are changes made on account of regulatory or administrative decisions for which the burden has been accounted for in different areas.

Annual Cost to Federal Government: $29,558

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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