View Information Collection Request (ICR) Package

View ICR - Agency Submission

OMB Control No: 0938-1295	ICR Reference No: 202602-0938-016
Status: Received in OIRA	Previous ICR Reference No: 202206-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Essential Community Provider Data Collection to Support QHP Certification (CMS-10561)
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: 02/19/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	19,020	0
Time Burden (Hours)	14,742	0
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	19,020	6,612	12,408
Annual Time Burden (Hours)	14,742	5,322	9,420
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: There is an overall increase in burden from the 2022 PRA package because of an overall increase in the number of providers that will be subject to the application renewal requirement in 2025. The total number of respondents have increased from 12,408 respondents to 19,020, an increase of 6,612. The number of burden hours increased from 3,140 to 4,914 (14,742 for 3 years), an increase of 1,773.75 hours (+5,322 hours for 3-years). The estimated annual cost increased from $187,238.28 to $312,514.50, an increase of $125,276.22.

Annual Cost to Federal Government: $314,961

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: Jamaa Hill 301 492-4190

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.