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OMB Control No: 0938-0798	ICR Reference No: 202607-0938-015
Status: Received in OIRA	Previous ICR Reference No: 202408-0938-036
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: Prospective Payments for Hospital Outpatient Services and Supporting Regulations in 42 CFR 413.65 (CMS-R-240)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 09/02/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2027
Responses	13,657,144	15,510,900
Time Burden (Hours)	726,140	775,545
Cost Burden (Dollars)	0	0

Abstract: Section 413.65(b)(3) states that a provider which is seeking a determination of provider-based status for a facility not located on the provider's campus must submit an attestation of compliance with applicable provider-based requirements and must supply documentation supporting its attestation at the time the attestation is made. Section 413.65(a)(1)(ii) establishes a listing of specific facilities for which determinations for provider-based status for payment purposes are not made. services. . In addition, section 1866(b)(2) of the Act authorizes hospitals and other providers to impose deductible and coinsurance charges for facility services, but does not allow such charges by facilities or organizations which are not provider-based. Implementation of this provision requires that CMS have information from the required reports, so it can determine which facilities are provider-based. Section 6225 of the CAA requires that, as a condition of receiving payment under the OPPS as of January 1, 2028, an off-campus department of a provider obtain and bill under a separate NPI and that the main provider must submit a provider-based status attestation that the off-campus outpatient department is compliant with the requirements for such departments.

Authorizing Statute(s): PL: Pub.L. 105 - 33 4523 Name of Law: Prospective Payment System for Hospital Outpatient Services
   US Code: 42 USC 1395cc(b)(2) Name of Law: Agreements with providers of services; enrollment processes
   PL: Pub.L. 119 - 75 6225 Name of Law: Consolidated Appropriations Act, 2026

Citations for New Statutory Requirements: PL: Pub.L. 119 - 75 6225 Name of Law: Consolidated Appropriations Act, 2026

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV38	Proposed rulemaking	91 FR 41734	07/07/2026

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
(CMS-R-240) Prospective Payments for Hospital Outpatient Services and Supporting Regulations in 42 CFR 413.65

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	13,657,144	15,510,900	-1,853,756
Annual Time Burden (Hours)	726,140	775,545	-49,405
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: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: For provider attestations, the estimated number of responses has increased due to the section 6225 of the CAA requirement for main providers to submit attestations for off-campus provider-based departments. As such, the number of attestations has increased from 250 to 16,488 annually. However, due to the electronic standardized submission format being developed for the attestations, we estimate a decrease in the number of hours per response from 10 to 5. Overall, we estimate an increase in the total burden for provider attestation, primarily due to the increased number of responses. Previously approved hourly burden (775,545) and number of responses (15,510,900) previously approved were incorrectly calculated/approved and are being corrected during this PRA process. Burden (682,420) should have remained the same for the previously 2024 submission and is being increased for this PRA process.

Annual Cost to Federal Government: $4,854,397

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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