Hospitals and Health Care Complex Cost Report

Forms and Documents

Document Name	Status
Form CMS-2552-10 Hospitals and Health Care Complex Cost Report (CMS-2552-10) Form	Modified
CSM-2552-10_Responses to 60 Day Comments.xlsx Supplementary Document	2015-09-18
CMS-2552-10_PRA _Crosswalk.docx Supplementary Document	2015-09-18
CMS-2552-10 Supporting Statement - REVISED (5-12-16).docx Supporting Statement A	2016-05-12

IC Document Collections

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

ICR Details

OMB Control No: 0938-0050	ICR Reference No: 201509-0938-009
Status: Historical Active	Previous ICR Reference No: 201308-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: 2552-10
Title: Hospitals and Health Care Complex Cost Report
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/12/2016
	Date Received in OIRA: 09/18/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2019	36 Months From Approved	09/30/2016
Responses	6,157	0	6,171
Time Burden (Hours)	4,143,661	0	4,153,083
Cost Burden (Dollars)	0	0	0

---

Abstract: The Form CMS-2552-10 cost report is needed to determine a provider's reasonable costs incurred in furnishing medical services to Medicare beneficiaries and reimbursement due to or due from a provider.

---

Authorizing Statute(s): Statute at Large: 18 Stat. 1815 Name of Statute: null
   Statute at Large: 18 Stat. 1834 Name of Statute: null
   US Code: 42 USC 413.20 Name of Law: Financial data and reports
   PL: Pub.L. 111 - 148 3132, 10501(i)(3)(A) Name of Law: Affordable Care Act
   Statute at Large: 18 Stat. 1861 Name of Statute: null
   US Code: 42 USC 413.24 Name of Law: Adequate cost data and cost finding
  

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:
	80 FR 6726	02/06/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 56467	09/18/2015
Did the Agency receive public comments on this ICR? Yes

---

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	COST REPORT WORKSHEET

---

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	6,157	6,171	0	-14	0	0
Annual Time Burden (Hours)	4,143,661	4,153,083	0	-9,422	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: Changing Regulations

Short Statement: While the burden per provider has not changed, the overall hour burden has decreased due to a decrease in the number of respondent by 14, from 6,171 to 6,157 hospitals. Additionally, the overall cost burden increased due to the cost per response hourly rate increasing from $15 per hour to $20 per hour.

---

Annual Cost to Federal Government: $102,044,000

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]? 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? 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: 09/18/2015

---