Medical Loss Ratio - Quarterly Reporting for Mini-med Plans and Expatriate Plans

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10373 Quarterly Reporting	Form and Instruction	Modified	Available
CMS-10373.MLR Quarterly Forms Instructions with technical corrections(CLEAN).docx	Supplementary Document	Uploaded 2011-06-09	Available
CMS-10373.Justification of Nonmaterial modifications.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2011-06-09	Available
CMS-10373.Supporting Statement Part A.doc	Supporting Statement A	Uploaded 2011-06-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
197131	Quarterly Reporting	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1132	ICR Reference No: 201106-0938-010
Status: Historical Active	Previous ICR Reference No: 201103-0938-018
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medical Loss Ratio - Quarterly Reporting for Mini-med Plans and Expatriate Plans
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: 05/01/2011
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/15/2011
	Date Received in OIRA: 06/09/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2011	11/30/2011	11/30/2011
Responses	1,125	0	1,125
Time Burden (Hours)	69,750	0	69,750
Cost Burden (Dollars)	0	0	0

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Abstract: ection 2718 of the PHS Act requies health insurance issuers offering group or individual health insurance coverage to submit annual reports to the Secretary concerning the amount the issuer spends each year on claims, quality improvement expenses, non-cliams costs, Federal and State taxes and licensing or regulatory fees, and the amount of earned premium for the reporting year. Additionally, for 2011, the interim final rule (IFR) implementing this provision requires quarterly reporting for expatriate plans and mini-med plans. This request for the collection of information solely pertains to the quarterly reporting requirement provided for in the IFR.

Emergency Justfication: Please see the attached emergency justification.

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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: None

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

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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
Quarterly Reporting	CMS-10373, CMS-10373	Instrument ,   Instructions

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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	1,125	1,125	0	0	0	0
Annual Time Burden (Hours)	69,750	69,750	0	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:

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Annual Cost to Federal Government: $21,600

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: 06/09/2011

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