Hospitals and Health Care Complex Cost Report and Supporting Regulation in 42 CFR 413.20 and 413.24

Forms and Documents

Document Name	Status
Form CMS-2552-10 Hospitals and Health Care Complex Cost Report (CMS-2552-10) Form and Instruction	Modified
CMS-2552-10_Revisions-Crosswalk.pdf Supplementary Document	2013-08-08
CMS-2552-10_Supporting_Statement_Part_A.docx Supporting Statement A	2013-08-08

IC Document Collections

IC ID	Document Title	Status
7814	Hospitals and Health Care Complex Cost Report (CMS-2552-10) Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0050	ICR Reference No: 201308-0938-011
Status: Historical Active	Previous ICR Reference No: 201008-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: 20297
Title: Hospitals and Health Care Complex Cost Report and Supporting Regulation in 42 CFR 413.20 and 413.24
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/20/2013
	Date Received in OIRA: 08/09/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2016	36 Months From Approved	09/30/2013
Responses	6,171	0	6,174
Time Burden (Hours)	4,153,083	0	4,155,102
Cost Burden (Dollars)	0	0	0

---

Abstract: Form CMS 2552-10 is used by hospitals participating in the Medicare program to report the health care costs to determine the amount of reimbursable costs for services rendered to Medicare beneficiaries.

---

Authorizing Statute(s): Statute at Large: 18 Stat. 1815 Name of Statute: null
   Statute at Large: 18 Stat. 1861 Name of Statute: null
   US Code: 42 USC 1395g Name of Law: Payments to providers of services
   PL: Pub.L. 111 - 148 5503, 5504, 5508 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 27400	05/10/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 45203	07/26/2013
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
Hospitals and Health Care Complex Cost Report (CMS-2552-10)	CMS-2552-10, CMS-2552-10, CMS-2552-10	Hospitals and Health Care Complex Cost Report ,   Hospitals and Health Care Complex Cost Report ,   Hospitals and Health Care Complex Cost Report

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	6,171	6,174	0	-3	0	0
Annual Time Burden (Hours)	4,153,083	4,155,102	0	-2,019	0	0
Annual Cost Burden (Dollars)	0	0	0	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: Miscellaneous Actions

Short Statement: The changes to the burden are a result of: o The estimated number of respondents decreased by 3 (from 6,174 as of 03/02/2010 to 6,171 as of 03/11/2013). o On a per respondent basis, incorporating the added legislative requirements in the Patient Protection and Affordable Care Act (ACA) of 2010 and the Temporary Payroll Tax Cut Continuation Act of 2011 in the revised MCR has not changed burden. The hourly burden per provider is estimated to remain unchanged at 673 hours. o The standard rate per hour remains unchanged at $15.

---

Annual Cost to Federal Government: $95,042,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/09/2013

---