Information Collection Requirements Referenced in HIPAA for the Individual Market, Supporting Regulations 45 CFR 148, and Forms/Instructions

Forms and Documents

Document	Type	Status	Availability
Supplemental DOC R-205 WHCRA.doc	Supplementary Document	Uploaded 2009-08-04	Available
Supplemental DOC R-205 NMHPA.doc	Supplementary Document	Uploaded 2009-08-04	Available
Supplemantal DOC R-205 Respondents Burden Hours Version2.xls	Supplementary Document	Uploaded 2009-08-04	Repair queued
R-205 Supporting Statement Version2.doc	Supporting Statement A	Uploaded 2009-08-04	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
43665	Information Collection Requirements Referenced in HIPAA for the Individual Market, Supporting Regulations 45 CFR 148, and Forms/Instructions (CMS-R-205)		Modified

ICR Details

OMB Control No: 0938-0703	ICR Reference No: 200908-0938-001
Status: Historical Active	Previous ICR Reference No: 200605-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Information Collection Requirements Referenced in HIPAA for the Individual Market, Supporting Regulations 45 CFR 148, and Forms/Instructions
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/15/2009
	Date Received in OIRA: 08/04/2009
Terms of Clearance: This ICR is approved for 3 years on the understanding that none of the burden changes stem from regulation.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2012	36 Months From Approved	09/30/2009
Responses	2,979,801	0	2,987,501
Time Burden (Hours)	856,384	0	868,147
Cost Burden (Dollars)	0	0	0

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Abstract: Information collection requirements (ICRs) will ensure that issuers in the individual market comply with HIPAA title I, provide individuals with certificates of creditable coverage necessary to demonstrate prior creditable coverage and file documentation with CMS for review in a Federal direct enforcement state. ICRs must also ensure states' flexibility to implement state alternative mechanisms.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Research and Investigations
  

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:
	74 FR 16400	04/10/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 30576	06/26/2009
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
Information Collection Requirements Referenced in HIPAA for the Individual Market, Supporting Regulations 45 CFR 148, and Forms/Instructions (CMS-R-205)

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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	2,979,801	2,987,501	0	0	-7,700	0
Annual Time Burden (Hours)	856,384	868,147	0	0	-11,763	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:

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Annual Cost to Federal Government: $558,054

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)? No

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: 08/04/2009

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