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OMB Control No: 0938-0454	ICR Reference No: 202606-0938-008
Status: Received in OIRA	Previous ICR Reference No: 202212-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: Physician Certifications/Recertification's in Skilled Nursing Facilities Manual Instruction (CMS-R-5)
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: 06/11/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	3,882,413	0
Time Burden (Hours)	480,957	0
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,882,413	1,567,154	2,315,259
Annual Time Burden (Hours)	480,957	-41,242	522,199
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The change in burden is due to a 14% decrease in responses for SNF stays of up to 100 days.

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]? 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: Malcolm Wilson 667 414-0087 malcolm.wilson@cms.hhs.gov

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