Disclosure and Recordkeeping Requirements for Grandfathered Health Plans under the Affordable Care Act

ICR 201006-0938-005

OMB: 0938-1093

Federal Form Document

Forms and Documents
Document
Name
Status
Justification for No Material/Nonsubstantive Change
2010-06-11
Supplementary Document
2010-06-11
Supporting Statement A
2010-06-11
IC Document Collections
IC ID
Document
Title
Status
193232
Modified
ICR Details
0938-1093 201006-0938-005
Historical Active 201006-0938-003
HHS/CMS
Disclosure and Recordkeeping Requirements for Grandfathered Health Plans under the Affordable Care Act
No material or nonsubstantive change to a currently approved collection   No
Emergency 06/11/2010
Approved without change 07/21/2010
Retrieve Notice of Action (NOA) 06/11/2010
  Inventory as of this Action Requested Previously Approved
12/31/2010 12/31/2010 12/31/2010
20,508,000 0 20,508,000
53,000 0 53,000
318,000 0 0

The grandfathered health plan disclosure notice will be used by health plans to notify their beneficiaries that their plan is a grandfathered plan. In addition, it will provide contact information if the beneficiary has questions about their plans status. In addition, the health plan must maintain records that document its status as a grandfathered health plan. This information will be used by the Department to verify the status of the plan.
See attached emergency justification

PL: Pub.L. 111 - 148 1251 Name of Law: Preservation of right to maintain existing coverage.
  
None

Not associated with rulemaking

No

1
IC Title Form No. Form Name
Disclosure and Recordkeeping Requirements

  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 20,508,000 20,508,000 0 0 0 0
Annual Time Burden (Hours) 53,000 53,000 0 0 0 0
Annual Cost Burden (Dollars) 318,000 0 318,000 0 0 0
No
No

$0
No
No
Yes
Uncollected
No
Uncollected
William Parham 4107864669

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/11/2010


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