Medicare Advantage Program Requirements Referenced in 42 CFR Part 422

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-R-267.Attachments 5a-5c (Instructions)-11-7-08.doc	Supplementary Document	Uploaded 2008-11-10	Available
CMS-R-267.Attachment 4 (Agent Compensation Information Workbook)-11-7-08.xls	Supplementary Document	Uploaded 2008-11-10	Available
CMS-R-267.Attachment 3 (Covered Agent Information Sheets Workbook)-11-7-08.xls	Supplementary Document	Uploaded 2008-11-10	Available
CMS-R-267.Attachments 2a-2b (Structure Submission Form)-11-7-08.doc	Supplementary Document	Uploaded 2008-11-10	Available
CMS-R-267.Attachments 1a-1b (Certifications)-11-7-08.doc	Supplementary Document	Uploaded 2008-11-10	Available
CM2-PRA Burden Ests-4-4-08-includes-mini-reg.xls	Supplementary Document	Uploaded 2008-05-19	Available
CMS-R-267.Supporting Statement Part A-11-07-08.DOC	Supporting Statement A	Uploaded 2008-11-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8462	Medicare Advantage Program Requirements Referenced in 42 CFR Part 422 (CMS-R-267 for MAOs)		Modified
185236	Medicare Advantage Program Requirements Referenced in 42 CFR Part 422 (CMS-R-267 for Beneficiaries)		New

ICR Details

OMB Control No: 0938-0753	ICR Reference No: 200806-0938-001
Status: Historical Active	Previous ICR Reference No: 200504-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Advantage Program Requirements Referenced in 42 CFR Part 422
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: 11/12/2008
	Date Received in OIRA: 06/05/2008
Terms of Clearance: This ICR is approved, consistent with the provisions of the interim final rules it is associated with. Should CMS revise the interim final rules following the public comment period, CMS shall resubmit a revision request for this ICR as appropriate.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2011	36 Months From Approved	11/30/2008
Responses	9,000,670	0	13,121,407
Time Burden (Hours)	8,561,701	0	2,064,439
Cost Burden (Dollars)	0	0	0

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Abstract: This ICR collects information from Medicare Advantage plans and potential MA plans (applicants) to comply with the application requirements and contract provisions set forth in 42 CFR 422.

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Authorizing Statute(s): Statute at Large: 18 Stat. 1851 Name of Statute: null
   Statute at Large: 18 Stat. 1859 Name of Statute: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AP52	Final or interim final rulemaking	73 FR 54225	09/18/2008

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 8878	02/15/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 28484	05/16/2008
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Medicare Advantage Program Requirements Referenced in 42 CFR Part 422 (CMS-R-267 for MAOs)
Medicare Advantage Program Requirements Referenced in 42 CFR Part 422 (CMS-R-267 for Beneficiaries)

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ICR Summary of Burden

table that charts list 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	9,000,670	13,121,407	0	-670	-4,120,067	0
Annual Time Burden (Hours)	8,561,701	2,064,439	0	850,616	5,646,646	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a revision and reflects a change in the burden due to program growth associated with the Title II MMA requirements and publication of two rules. The burden increases associated with agency discretion stem from regulatory changes to the MA program, including the need to collect more information about agent and broker commissions and compensation structures over a multi-year period to ensure that agents and brokers are not improperly incentivized to "churn" beneficiaries from one plan to another without regard for the health benefits to the beneficiaries.

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Annual Cost to Federal Government: $0

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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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: 06/05/2008

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