Recovery Act of 2009 - Request for Expedited Review of Denial of Premium Assistance

Forms and Documents

Document Name	Status
Form CMS-10285 Recovery Act of 2009 - Request for Expedited Review of Denial of Premium Assistance Form and Instruction	New
CMS-10285 Response to Public Comment 5_20_09_CPC.doc Supplementary Document	2009-05-20
Draft Emergency FR notice.doc Supplementary Document	2009-04-30
Revised Emergency PRA justification--COBRA form(3).doc Supplementary Document	2009-04-29
FR PUB Confirmation.docx Supplementary Document	2009-04-30
PRA Supp Statement--COBRA 04-30-09_FNL.doc Supporting Statement A	2009-04-30

IC Document Collections

IC ID	Document Title	Status
189030	Recovery Act of 2009 - Request for Expedited Review of Denial of Premium Assistance Form and Instruction	New

ICR Details

OMB Control No: 0938-1062	ICR Reference No: 200905-0938-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Recovery Act of 2009 - Request for Expedited Review of Denial of Premium Assistance
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 05/15/2009
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/20/2009
	Date Received in OIRA: 05/04/2009
Terms of Clearance: This is approved as an emergency collection. We look forward to working with the Department on ways to improve the practical utility of this form while reducing the burden. By the next submission, the Department will be prepared to describe how it uses all of the data collected to carry out program objectives.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2009	6 Months From Approved
Responses	12,000	0	0
Time Burden (Hours)	12,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The American Recovery and Reinvestment Act of 2009 (P.L. 111-5) provides for premium assistance and expanded eligibility for health benefits under the Consolidated Omnibus Budget Reconciliation Act of 1986, commonly called COBRA and for comparable state continuation coverage programs. This premium assistance is not paid directly to the covered employee or the qualified beneficiary, but instead is in the form of a tax credit for the health plan, the employer, or the insurer. An individual must be an "assistance eligible individual" to be eligible for the premium assistance. If individuals request treatment as an assistance eligible individual and are denied such treatment because of their ineligibility for the reduced premium assistance, the Secretary of Health and Human Services must provide for expedited review of the denial upon application to the Secretary in the form and manner the Secretary provides. The Secretary is required to make a determination within 15 business days after receipt of an individual's application for review. The Request for Expedited Review of Denial of Premium Assistance (the "Application") is the form that will be used by individuals to file their expedited review appeals. Such individuals must complete all information requested on the Application in order to file their review requests with CMS. An Application may be denied if sufficient information is not provided.

Emergency Justfication: Justification for Emergency PRA Clearance of the Application for Expedited Review of Denials of Continuation Coverage Premium Assistance, see attached emergency justification document.

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Authorizing Statute(s): PL: Pub.L. 111 - 5 301(a)(5) Name of Law: Premium Assistance for Cobra Benefits
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 5 3001(a)(5) Name of Law: Premium Assistance For Cobra Benefits

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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
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 20483	05/04/2009
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Recovery Act of 2009 - Request for Expedited Review of Denial of Premium Assistance	CMS-10285	Request for Expedited Review of Denial of Premium Assistance

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ICR Summary 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	12,000	0	12,000	0	0	0
Annual Time Burden (Hours)	12,000	0	12,000	0	0	0
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: No

Burden Reduction Due to:

Short Statement: Increase in burden occurred because of new statutory obligation under ARRA section 3001 (enacted on February 17, 2009) to conduct expedited reviews of denials of continuation coverage assistance.

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Annual Cost to Federal Government: $1,000,000

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)? Yes

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: 05/04/2009

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