Application for Coverage in the Pre-Existing Condition Insurance Plan

ICR 201008-0938-016

OMB: 0938-1095

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-1095 201008-0938-016
Historical Active 201006-0938-012
HHS/CMS
Application for Coverage in the Pre-Existing Condition Insurance Plan
No material or nonsubstantive change to a currently approved collection   No
Emergency 06/28/2010
Approved without change 09/02/2010
Retrieve Notice of Action (NOA) 08/23/2010
OMB acknowledges CMS compliance with the prior terms of clearance.
  Inventory as of this Action Requested Previously Approved
12/31/2010 12/31/2010 12/31/2010
399,999 0 399,999
233,999 0 233,999
0 0 0

The data collection will be used by HHS to obtain information from potential eligible individuals applying for coverage in the PCIP. On March 23, 2010, the President signed into law H.R. 3590, the Patient Protection and Affordable Care Act (Affordable Care Act), Public Law 111-148. Section 1101 of the law establishes a "temporary high risk health insurance pool program" (which has been named the Pre-Existing Condition Insurance Plan, or PCIP) to provide health insurance coverage to currently uninsured individuals with pre-existing conditions. The law authorizes HHS to carry out the program directly or through contracts with states or private, non-profit entities.
In accordance with Section 1101 of The Patient Protection and Affordability Care Act, H.R. 3590 the U.S. Department of Health and Human Services (HHS) is tasked with establishing a "temporary high risk health insurance pool program" to provide health insurance coverage to currently uninsured individuals with pre-existing conditions. This temporary high risk health insurance pool program has a statutory implementation date of July 1, 2010. Due to the urgency and the short time frames associated with this requirement, HHS does not have sufficient time to follow the normal notice and comment periods associated with the normal OMB approval process. Therefore, we are requesting an emergency review and approval for this information collection request.

PL: Pub.L. 111 - 148 1101 Name of Law: Immediate access to insurance for uninsured individuals with a preexisting
  
None

Not associated with rulemaking
Other Documents for OIRA Review

No

8
IC Title Form No. Form Name
Application and Eligibility (2010) CMS-10334, CMS-10334
Premium Payment (2010) CMS-10334, CMS-10334
Application and Eligibility (2011) CMS-10334, CMS-10334
Premium Payment (2011) CMS-10334, CMS-10334
Application and Eligibility (2012) CMS-10334, CMS-10334
Premium Payment (2012) CMS-10334, CMS-10334
Application and Eligibility (2013) CMS-10334, CMS-10334
Premium Payment (2013) CMS-10334, CMS-10334

  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 399,999 399,999 0 0 0 0
Annual Time Burden (Hours) 233,999 233,999 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$20
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.
08/23/2010


© 2024 OMB.report | Privacy Policy