End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133 (CMS-2744)

Forms and Documents

Document Name	Status
Form CMS-2744A&B End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133 Form	Modified
CMS- 2744 Response to Public Comments 1-17-25.docx Supplementary Document	2025-06-03
CMS-2744 Supporting Statement Part B 1-17-25.docx Supporting Statement B	2025-06-03
CMS- 2744 Supporting Statement 1-17-25.docx Supporting Statement A	2025-06-03

IC Document Collections

IC ID	Document Title	Status
8062	End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133 Form	Modified

ICR Details

OMB Control No: 0938-0447	ICR Reference No: 202505-0938-013
Status: Received in OIRA	Previous ICR Reference No: 202005-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133 (CMS-2744)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/17/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	7,726	0
Time Burden (Hours)	15,452	0
Cost Burden (Dollars)	0	0

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Abstract: The ESRD Facility Survey form (CMS-2744) is completed annually by Medicare-approved providers of dialysis and transplant services. The CMS-2744 is designed to collect information concerning treatment trends utilization of services and patterns of practice in treating ESRD patients.

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Authorizing Statute(s): PL: Pub.L. 95 - 292 1881 Name of Law: Medicare Coverage for End Stage Renal Disease Patients
  

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:
	89 FR 80903	11/25/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 23054	05/30/2025
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
End Stage Renal Disease Medical Information System ESRD Facility Survey and Supporting Regulations in 42 CFR 405.2133	CMS-2744 B, CMS-2744A&B	END STAGE RENAL DISEASE MEDICAL INFORMATION SYSTEM ESRD FACILITY SURVEY ,   ESRD Medical Information System ESRD Facility Survey

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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	7,726	0	0	-102	0	7,828
Annual Time Burden (Hours)	15,452	0	0	-15,860	0	31,312
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: There is a change in total estimated burden hours to 15,452 from the previously estimated hours of 31,312. The number of dialysis facilities has decreased and therefore the number of submissions of CMS-2744 forms to 7,726 submissions estimated for January 1, 2023 thru December 31,2023 from the previously estimate of 7,828 submissions from January 1, 2021 thru December 31, 2021.

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Annual Cost to Federal Government: $414,654

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: 06/17/2025

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