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OMB Control No: 0938-1177	ICR Reference No: 202607-0938-009
Status: Received in OIRA	Previous ICR Reference No: 202310-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Beneficiary and Family Centered Data Collection (CMS-10393)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 07/27/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2027
Responses	9,000	9,000
Time Burden (Hours)	2,250	2,250
Cost Burden (Dollars)	31,365	31,365

Annual Cost to Federal Government: $4,299

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

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