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OMB Control No: 0938-1271	ICR Reference No: 202607-0938-004
Status: Received in OIRA	Previous ICR Reference No: 202205-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: CM
Title: Good Cause Processes (CMS-10544)
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: 07/17/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	54,789	0
Time Burden (Hours)	36,490	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	54,789	13,500	41,289
Annual Time Burden (Hours)	36,490	8,991	27,499
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: The annual burden hours have increased from 27,499 to 36,490 as a result of the increase in the number of respondents from 41,289 to 54,789.

Annual Cost to Federal Government: $116

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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