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OMB Control No:	ICR Reference No: 202606-0938-023
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Submissions of Acute Hospital Care at Home (AHCAH) Waiver Submission and Data Collection (CMS-10950)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 07/02/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	1,947	0
Time Burden (Hours)	1,947	0
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Change Due to Agency Discretion
Annual Number of Responses	1,947	1,947
Annual Time Burden (Hours)	1,947	1,947
Annual Cost Burden (Dollars)	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: No

Burden Reduction Due to:

Short Statement: The annual burden hours have increased from 1,521 to 1,947 due to the increase number of waiver submissions and the addition of the data submission. The wage rates have been updated to year 2023. The annual cost has changed from $125,969.22 to $159,422.91.

Annual Cost to Federal Government: $9,515

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? Yes

Agency Contact: Denise King 410 786-1013 Denise.King@cms.hhs.gov

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