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OMB Control No: 0938-1495	ICR Reference No: 202608-0938-020
Status: Received in OIRA	Previous ICR Reference No: 202603-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: FCHCO
Title: Passive Enrollment Processes for D-SNPs (CMS-10953)
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: 08/27/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	22	0
Time Burden (Hours)	1,100	0
Cost Burden (Dollars)	114,686	0

ICR Summary of Burden

	Total Request	Change Due to Agency Discretion
Annual Number of Responses	22	22
Annual Time Burden (Hours)	1,100	1,100
Annual Cost Burden (Dollars)	114,686	114,686

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: This new iteration adds 11 responses, 1,100 hours with a labor related cost of $89,161 and a non-labor cost of $114,686. Otherwise, there are no changes since this is a new collection of information request.

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: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov

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