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OMB Control No: 0945-0008	ICR Reference No: 202603-0945-001
Status: Received in OIRA	Previous ICR Reference No: 202302-0945-001
Agency/Subagency: HHS/OCR	Agency Tracking No:
Title: Assurance and Certification of Compliance
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 04/24/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	05/31/2026
Responses	8,486	360,231
Time Burden (Hours)	33,944	1,317,646
Cost Burden (Dollars)	0	0

Authorizing Statute(s): PL: Pub.L. 115 - 31 507(d) Name of Law: Consolidated Appropriations Act
   PL: Pub.L. 131 - 135 209 Name of Law: Weldon language applied to Medicare Advantage
   US Code: 42 USC 18023(c) Name of Law: Affordable Care Act
   US Code: 42 USC 300a-7 Name of Law: Church Amendment
   US Code: 20 USC 1681 Name of Law: Title IX of the Education Amendments of 1972
   US Code: 42 USC 238n Name of Law: Coats-Snowe Amendment,

Citations for New Statutory Requirements: None

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	8,486	360,231	-351,745
Annual Time Burden (Hours)	33,944	1,317,646	-1,283,702
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: Using Information Technology

Short Statement: As Applicants/Recipients now may file electronically via the electronic portal, the burden was reduced in not requiring additional documentation. OCR expects the majority of respondents to complete the form through electronic submission.

Annual Cost to Federal Government:

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: Harold Henderson 202 868-9407 harold.henderson@hhs.gov

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