Medical Loss Ratio (IFR) Information Collection Requirements and Supporting Regulations

Forms and Documents

Document Name	Status
Form CMS-10361 Waiver Application Form and Instruction	New
CMS-10361 Supporting Statement Part A (11-18-10).doc Supporting Statement A	2010-11-23

IC Document Collections

IC ID	Document Title	Status
195389	Record Retention Requirement	New
195248	Waiver Application Form and Instruction	New

ICR Details

OMB Control No: 0938-1114	ICR Reference No: 201012-0938-003
Status: Historical Active	Previous ICR Reference No: 201011-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medical Loss Ratio (IFR) Information Collection Requirements and Supporting Regulations
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/02/2010
	Date Received in OIRA: 12/02/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2011	6 Months From Approved
Responses	462	0	0
Time Burden (Hours)	4,142	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The State application will be used by HHS to determine whether an adjustment to the minimum MLR in the individual market in a state is warranted to prevent market destabilization. HHS may also publish some of the state information as well as the Agency's assessment of the sufficiency of the information to determine that a destabilization risk is likely.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 2718 Name of Law: BRINGING DOWN THE COST OF HEALTH CARE COVERAGE.
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 2718 Name of Law: BRINGING DOWN THE COST OF HEALTH CARE COVERAGE.

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0950-AA06	Final or interim final rulemaking	75 FR 74864	12/01/2010

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Record Retention Requirement
Waiver Application	CMS-10361	CMS.10361.Deliberative Document

---

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	462	0	462	0	0	0
Annual Time Burden (Hours)	4,142	0	4,142	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: This is a new information collection request.

---

Annual Cost to Federal Government: $43,200

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]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(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: 11/12/2010

---