Grants to States for Health Insurance Premium Review - Cycles I and II

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
196347	(Cycle II ) Final Report - end of grant		New
196346	(Cycle II) Annual Report		New
196345	(Cycle II) Transaction Data Collection		New
196344	(Cycle II) Quarterly Report		New
196343	(Cycle II) Application		New
196342	(Cycle I) Application re-release		New
196341	(Cycle I) Transaction Data Collection		New
196340	(Cycle I) Quarterly Reports		New

ICR Details

OMB Control No: 0938-1121	ICR Reference No: 201102-0938-012
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Grants to States for Health Insurance Premium Review - Cycles I and II
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 02/25/2011
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/24/2011
	Date Received in OIRA: 02/24/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2011	6 Months From Approved
Responses	964	0	0
Time Burden (Hours)	52,292	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The data collection will be used by HHS to request that States and territories submit the following: o An application to apply for the Cycle II Premium Review Grants. Guidance requirements for the application are provided beginning on page 14 of the funding opportunity announcement. o Four quarterly reports to the Secretary detailing the States' progression towards a more comprehensive rate review process, utilizing funds awarded in Cycle II Health Insurance Premium Review Grants. Data elements are consistent with data elements in Cycle I Premium Review Grants. The data elements are described in the Cycle I funding opportunity announcement found at http://www.grants.gov/search/search.do?mode=VIEW&oppId=55029. o Rate review transaction data collected by the State. o One annual report. o One final report at the end of the grant. This above information will assist HHS in planning for and executing grants to States for health insurance premium review. In addition, reporting of information by grant awardees will assist HHS in assuring that grant awardees report and share data with the Secretary as required by the grant program.

Emergency Justfication: Please see the attached emergency justification.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1003 Name of Law: Ensuring that consumers get value for their dollars
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1003 Name of Law: Ensuring that consumers get value for their dollars.

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking
	Other Documents for OIRA Review

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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: 8

table that charts list of burden

IC Title	Form No.	Form Name
(Cycle I) Quarterly Reports	CMS-10380
(Cycle I) Transaction Data Collection	CMS-10380
(Cycle I) Application re-release	CMS-10380
(Cycle II) Application	CMS-10380
(Cycle II) Quarterly Report	CMS-10380
(Cycle II) Transaction Data Collection	CMS-10380
(Cycle II) Annual Report	CMS-10380
(Cycle II ) Final Report - end of grant	CMS-10380

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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	964	0	506	458	0	0
Annual Time Burden (Hours)	52,292	0	36,340	15,952	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Cycle I of this program was previously approved under OMB control number 0938-1092. Once this new collection, which includes no changes to Cycle I but the addition of a separate Cycle II is approved, we will discontinue the OMB control number for 0938-1092.

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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]? 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

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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: 02/24/2011

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