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OMB Control No: 0938-1344	ICR Reference No: 202602-0938-008
Status: Received in OIRA	Previous ICR Reference No: 202111-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Coverage of Certain Preventive Services Under the Affordable Care Act (CMS-10653)
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: 02/09/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	595,312	0
Time Burden (Hours)	72	0
Cost Burden (Dollars)	151,209	0

Authorizing Statute(s): PL: Pub.L. 111 - 148 1001 Name of Law: Amendments to the Public Health Service Act
   PL: Pub.L. 111 - 148 1563 Name of Law: Conforming amendments
   EO: EO 13798 Name/Subject of EO: Executive Order Promoting Free Speech and Religious Liberty
   US Code: 42 USC 300gg-13 Name of Law: Coverage of preventive health services
   EO: EO 13765 Name/Subject of EO: Executive Order Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pen

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1001 Name of Law: Amendments to the Public Health Service Act
PL: Pub.L. 111 - 148 1563 Name of Law: Conforming amendments
US Code: 42 USC 300gg-13 Name of Law: Coverage of preventive health services

Annual Cost to Federal Government: $0

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]? Yes

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: William Parham 410 786-4669 william.parham@cms.hhs.gov

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