[Medicaid] Limitations on Provider Related Donations and Health Care Related Taxes; Medicaid and Supporting Regulations in 42 CFR 433.68 and 433.74 (CMS-R-148)

Forms and Documents

Document Name	Status
CMS-R-148 - Supporting Statement A (CMS-2448-P version 6).docx Supporting Statement A	2025-09-12

IC Document Collections

IC ID	Document Title	Status
8216	Limitations on Provider Related Donations and Health Care Related Taxes, etc.	Unchanged
277539	Proposed One-Time Reporting and Recordkeeping Requirement	New

ICR Details

OMB Control No: 0938-0618	ICR Reference No: 202509-0938-013
Status: Received in OIRA	Previous ICR Reference No: 202405-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: [Medicaid] Limitations on Provider Related Donations and Health Care Related Taxes; Medicaid and Supporting Regulations in 42 CFR 433.68 and 433.74 (CMS-R-148)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/15/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	09/30/2027
Responses	48	40
Time Burden (Hours)	3,840	3,200
Cost Burden (Dollars)	0	0

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Abstract: This information collection is necessary to ensure compliance with Sections 1903 and 1923 of the Social Security Act for the purpose of preventing payment of FFP on amounts prohibited by statute.

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Authorizing Statute(s): US Code: 42 USC 433. Name of Law: 74
   US Code: 42 USC 433 Name of Law: 272
   US Code: 42 USC 433 Name of Law: .68
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV58	Proposed rulemaking	90 FR 20578	05/15/2025

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 20578	05/15/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Limitations on Provider Related Donations and Health Care Related Taxes, etc.
Proposed One-Time Reporting and Recordkeeping Requirement

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ICR Summary 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	48	40	0	8	0	0
Annual Time Burden (Hours)	3,840	3,200	0	640	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: We anticipate that the provisions of this proposed rule may require seven States to submit a total of eight new waiver proposals within 2 years of the effective date of the subsequent final rule that demonstrate compliance with the updated requirements. Consistent with our active (or currently approved) estimates under the aforementioned OMB control number, we continue to estimate that it would take 80 hours at $46.88/hr for a health care support worker to prepare and submit the waiver request. In aggregate, we estimate a one-time burden of 640 hours (8 waivers x 80 hr/waiver) at a cost of $30,003 (640 hr x $46.88/hr). When taking into account the Federal administrative match of 50 percent, we estimate a one-time State cost of $15,002 ($30,003 * 0.5).

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Annual Cost to Federal Government: $24,036

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: 09/15/2025

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