View Information Collection Request (ICR) Package

View ICR - Agency Submission

OMB Control No: 0938-0778	ICR Reference No: 202605-0938-006
Status: Received in OIRA	Previous ICR Reference No: 202302-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Medicare Advantage Appeals and Grievance Data Form (CMS-R-282)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 05/13/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2026
Responses	67,432	63,740
Time Burden (Hours)	6,252	5,964
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	67,432	63,740	3,692
Annual Time Burden (Hours)	6,252	5,964	288
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 in the number of MA eligible beneficiaries that may request this report (due to an increased number of Medicare beneficiaries).

Annual Cost to Federal Government: $992

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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