2024-23708. Agency Information Collection Activities: Proposed Collection; Comment Request

Exhibit 1—Estimated Annualized Burden Hours

Form	Number of respondents	Number of responses per respondent	Hours per response	Total burden Hours
1. PSO Certification for Initial Listing Form	11	1	18	198
2. PSO Certification for Continued Listing Form	40	1	8	320
3. PSO Two Bona Fide Contracts Requirement Form	56	1	1	56
4. PSO Disclosure Statement Form	3	1	3	9
5. PSO Profile Form	74	1	3	222
6. PSO Change of Listing Information	51	1	05/60	4.25
7. PSO Voluntary Relinquishment Form	4	1	30/60	2
8. OCR Patient Safety Confidentiality Complaint Form	1	1	20/60	.33
9. Common Formats	1,000	1	100	100,000
Total		NA	NA	100,811.58

Exhibit 2—Estimated Annualized Cost Burden

Form	Total burden hours	Average hourly wage rate *	Total cost
1. PSO Certification for Initial Listing Form	198	$49.07	$9,715.86
2. PSO Certification for Continued Listing Form	320	49.07	15,702.40
3. PSO Two Bona Fide Contracts Requirement Form	56	49.07	2,747.92
4. PSO Disclosure Statement Form	9	49.07	441.63
5. PSO Profile Form	222	49.07	10,893.54
6. PSO Change of Listing Form	4.25	49.07	208.55
7. PSO Voluntary Relinquishment Form	2	49.07	98.14
8. OCR Patient Safety Confidentiality Complaint Form	.33	49.07	15.35
9. Common Formats	100,000	49.07	4,907,000
Total			4,946,824.23
* Based upon the mean of the hourly average wages for healthcare practitioner and technical occupations, 29-0000, National Compensation Survey, May 2023, “U.S. Department of Labor, Bureau of Labor Statistics.” https://www.bls.gov/​oes/​current/​oes290000.htm