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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10325 (0938-1093) Justification of Nonmaterial.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2010-06-11	Available
CMS-10325.Emergency Justification.docx	Supplementary Document	Uploaded 2010-06-11	Available
CMS-10325.REVISED - Supporting Statement Part A (6-10-10).doc	Supporting Statement A	Uploaded 2010-06-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
193232	Disclosure and Recordkeeping Requirements		Modified

ICR Details

OMB Control No: 0938-1093	ICR Reference No: 201006-0938-005
Status: Historical Active	Previous ICR Reference No: 201006-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Disclosure and Recordkeeping Requirements for Grandfathered Health Plans under the Affordable Care Act
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 06/11/2010
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/21/2010
	Date Received in OIRA: 06/11/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2010	12/31/2010	12/31/2010
Responses	20,508,000	0	20,508,000
Time Burden (Hours)	53,000	0	53,000
Cost Burden (Dollars)	318,000	0	0

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Abstract: 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.

Emergency Justfication: See attached emergency justification

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1251 Name of Law: Preservation of right to maintain existing coverage.
  

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

Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Disclosure and Recordkeeping Requirements

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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	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

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: $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]? Yes

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: 06/11/2010

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