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OMB Control No: 0938-0926	ICR Reference No: 202611-0938-008
Status: Received in OIRA	Previous ICR Reference No: 202509-0938-017
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: The In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems Survey Mode Experiment (CMS-10105)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 11/06/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	02/28/2029
Responses	211,770	207,500
Time Burden (Hours)	42,269	41,500
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	211,770	207,500	4,270
Annual Time Burden (Hours)	42,269	41,500	769
Annual Cost Burden (Dollars)	0	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 current annualized burden for the national implementation of the ICH CAHPS Survey is 41,500 hours. Adding the one-time mode experiment to the national implementation data collection, which is estimated at 768.6 hours, increases the annualized hour burden to 42,268.6 hours.

Annual Cost to Federal Government: $2,392,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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]? Yes

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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