Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b) (CMS-10242)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10242 Supporting Statement A.docx	Supporting Statement A	Uploaded 2026-04-21	Available
Response to Public Comments Ambulance PRA.docx	Supplementary Document	Uploaded 2023-04-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
184092	Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b)		Modified

ICR Details

OMB Control No: 0938-1049	ICR Reference No: 202604-0938-019
Status: Received in OIRA	Previous ICR Reference No: 202304-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b) (CMS-10242)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/22/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2026
Responses	9,265,931	10,954,288
Time Burden (Hours)	771,852	912,492
Cost Burden (Dollars)	0	0

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Abstract: Because it is very difficult to obtain a beneficiary's signature (or the signature of a person authorized to sign on behalf of the beneficiary) on a claim when the beneficiary is being transported by ambulance in emergency situations, we are proposing that, for emergency ambulance transport services, an ambulance provider or supplier may submit the claim without a beneficiary's signature, as long as certain documentation requirements are met.

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Authorizing Statute(s): Statute at Large: 18 Stat. 1835
   Statute at Large: 18 Stat. 1842
   Statute at Large: 18 Stat. 1848
   Statute at Large: 18 Stat. 1814
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 2936	01/23/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 20998	04/20/2026
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Emergency Ambulance Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b)

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	9,265,931	10,954,288	0	-1,688,357	0	0
Annual Time Burden (Hours)	771,852	912,492	0	-140,640	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 decrease in burden is due to an overall decrease in the number of Part B- paid ambulance transport claims.

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Annual Cost to Federal Government:

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

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Common Form ICR:  No

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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: 04/22/2026

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