Rate Increase Disclosure and Review Reporting Requirements (45 CFR Part 154)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Preliminary Instructions.pdf	Supplementary Document	Uploaded 2011-08-23	Available
Preliminary Justification Submission Function.docx	Supplementary Document	Uploaded 2011-08-23	Available
issuer_module_1_reporting_requirements_slides.pdf	Supplementary Document	Uploaded 2011-08-19	Available
CMS-10379.Rate Summary Form (7-12-11) w comment changes highlighted.xls	Supplementary Document	Uploaded 2011-07-20	Available
CMS-10379.PJ Instructions (7-12-11).doc	Supplementary Document	Uploaded 2011-07-20	Available
CMS-10379.KY examples (7-12-11).xlsx	Supplementary Document	Uploaded 2011-07-20	Available
CMS-10379.Examples (7-12-11).pdf	Supplementary Document	Uploaded 2011-07-20	Available
CMS-10379.Discussion of the examples (7-12-11).docx	Supplementary Document	Uploaded 2011-07-20	Available
CMS-10379.Synopsis of Comments on the PRA package (7-12-11).docx	Supplementary Document	Uploaded 2011-07-20	Available
Consumer Disclosure.pdf	Supplementary Document	Uploaded 2011-06-08	Available
Rate Summary Worksheet.pdf	Supplementary Document	Uploaded 2011-06-08	Available
PRA Response to Comments_052411.docx	Supplementary Document	Uploaded 2011-06-08	Available
CMS-10379.REVISED (CLEAN) Supporting Statement Part A (8-19-11).doc	Supporting Statement A	Uploaded 2011-08-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
198023	Ongoing Compliance (2012-2013)		New
198022	State Unreasonable Rate Increase Determinations		New
198021	One-Time Health Insurance Issuer Start-Up Costs		New
198020	Health Insurance Issuer Submission of Final Justification for Unreasonable Rate Increases	Other-Word Document	New
198019	Health Insurance Issuer Submission of the Preliminary Justification	Other-Word Document	New

ICR Details

OMB Control No: 0938-1141	ICR Reference No: 201106-0938-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Rate Increase Disclosure and Review Reporting Requirements (45 CFR Part 154)
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 with change	Conclusion Date: 08/23/2011
	Date Received in OIRA: 06/08/2011
Terms of Clearance: By the time of the next submission, the agency will provide an overview of the steps taken to minimize burden and avoid duplicative collections, especially with regard to the preliminary and secondary justifications.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2014	36 Months From Approved
Responses	3,435	0	0
Time Burden (Hours)	86,656	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection request includes collections related to implementation of the Affordable Care Act Rate Increase Disclosure and Review Reporting Requirements.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1003 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1003 Name of Law: Affordable Care Act

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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
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 11248	03/01/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 31613	06/01/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Ongoing Compliance (2012-2013)
Health Insurance Issuer Submission of the Preliminary Justification
Health Insurance Issuer Submission of Final Justification for Unreasonable Rate Increases
One-Time Health Insurance Issuer Start-Up Costs
State Unreasonable Rate Increase Determinations

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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	3,435	0	3,435	0	0	0
Annual Time Burden (Hours)	86,656	0	86,656	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 collection.

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Annual Cost to Federal Government: $2,339,350

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: 06/08/2011

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