2024-18003. Agency Information Collection Activities: Proposed Collection; Comment Request

Exhibit 1—Estimated Annualized Burden Hours

Form name	Number of respondents/ POCs	Number of responses per POC	Hours per response	Total burden hours
1. Eligibility and Registration Form	60	1	3/60	3
2. ASC Site Information	60	4	5/60	20
3. Data Use Agreement	60	1	3/60	3
4. SOPS ASC Survey Data Files Submission	60	1	1	60
( print page 65914)
Total	NA	NA	NA	86

Exhibit 2—Estimated Annualized Cost Burden

Form name	Total burden hours	Average hourly wage rate *	Total cost burden
1. Eligibility and Registration Form	3	$50.99	$153
2. ASC Site Information	20	50.99	1,020
3. Data Use Agreement	3	50.99	153
4. SOPS ASC Survey Data Files Submission	60	50.99	3,060
Total	86	NA	4,386
* Based on the mean hourly wage for 60 ASC Administrative Services Managers (11-3010; $50.99) obtained from the May 2023 National Industry-Specific Occupational Employment and Wage Estimates: NAICS 621400—Outpatient Care Centers (located at https://www.bls.gov/​oes/​current/​naics4_​621400.htm#11-00000).