Information Collection Request

Health Care Reform Insurance Web Portal and Supporting Authority Contained in Sections 1103 and 10102 of The Patient Protection and Affordability Care Act, P.L. 111-148 (PPACA)

ICR 201109-0938-003 · OMB 0938-1086 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10320 Issuer - Attest (Small Group) Form and Instruction New Available
Form CMS-10320 Issuer - Attest (Individual) Form and Instruction New Available
Form CMS-10320 Issuer - Troubleshoot (Small Group) Form and Instruction New Available
Form CMS-10320 Issuer - Troubleshoot (Individual) Form and Instruction New Available
Form CMS-10320 Issuer - Data Entry (Small Group) Form and Instruction New Available
Form CMS-10320 Issuer - Data Entry (Individual) Form and Instruction New Available
Form CMS-10320 Issuers - Submission Preparation (Small Group) Form and Instruction New Available
Form CMS-10320 Issuers - Submission Preparation (Individual) Form and Instruction New Available
Form CMS-10320 Issuers Training and Communication Form and Instruction New Available
Form CMS-10320 States - Data Collection Form and Instruction New Available
Form CMS-10320 Query Writing and Record Processing Form and Instruction Removed Available
Form CMS-10320 Premium Estimation Process Form and Instruction Removed Repair queued
Form CMS-10320 Issuers - Pricing and Benefit Updates Form and Instruction Removed Available
Form CMS-10320 Issuers - Pricing and Benefit data Form and Instruction Removed Available
Form CMS-10320 Issuers - Basic Information Submission Form and Instruction Removed Repair queued
Form CMS-10320 Issuers - Training, reviewing regulation, and analyzing data Form and Instruction Removed Repair queued
Form CMS-10320 States - Training, reviewing regulation, and analyzing data Form and Instruction Modified Available
Form CMS-10320 States - Data submission Form and Instruction Modified Repair queued
CMS-10320.Terms of Approval Implementation (10-7-11)-1.docx Supplementary Document Uploaded 2011-10-07 Available
CMS-10320.Crosswalk (changes as of 10-7-11).doc Supplementary Document Uploaded 2011-10-07 Available
CMS-10320.Crosswalk (changes as of 8-4-11).doc Supplementary Document Uploaded 2011-10-07 Available
CMS-10320.CCIIO_replies_PRA_AHIPComment (10-7-11)-1.docx Supplementary Document Uploaded 2011-10-07 Available
Appendix_D_BenefitsPremiumsInformation(10-7-11).docx Supplementary Document Uploaded 2011-10-07 Available
RBIS_SG_Regions_Template_v1.xls Supplementary Document Uploaded 2011-09-15 Available
RBIS_SG_Product_Availability_Template_v1.xls Supplementary Document Uploaded 2011-09-15 Available
RBIS_SG_Business_Rules_Template_v1.xls Supplementary Document Uploaded 2011-09-15 Available
RBIS_SG_Benefit_Template-draft_v3.xls Supplementary Document Uploaded 2011-09-15 Repair queued
Individual-plan-benefits-template.pdf Supplementary Document Uploaded 2011-09-15 Available
20110815_SG_Wireframes.pdf Supplementary Document Uploaded 2011-09-15 Available
20110815_SG_NonBenefitTemplateFields.pdf Supplementary Document Uploaded 2011-09-15 Available
20110815_SG_BenefitFields.pdf Supplementary Document Uploaded 2011-09-15 Available
Appendix_F_PoolRequirements.doc Supplementary Document Uploaded 2011-09-15 Available
Appendix_B_Section1103.docx Supplementary Document Uploaded 2011-09-09 Available
Appendix_A_Portal_Supporting_Statement(10-7-11).doc Supporting Statement A Uploaded 2011-10-07 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
199284 Issuer - Attest (Small Group) Form and Instruction New
199283 Issuer - Attest (Individual) Form and Instruction New
199282 Issuer - Troubleshoot (Small Group) Form and Instruction New
199281 Issuer - Troubleshoot (Individual) Form and Instruction New
199280 Issuer - Data Entry (Small Group) Form and Instruction New
199279 Issuer - Data Entry (Individual) Form and Instruction New
199278 Issuers - Submission Preparation (Small Group) Form and Instruction New
199277 Issuers - Submission Preparation (Individual) Form and Instruction New
199276 Issuers Training and Communication Form and Instruction New
199275 States - Data Collection Form and Instruction New
194217 Query Writing and Record Processing Form and Instruction Removed
194216 Premium Estimation Process Form and Instruction Removed
192730 Issuers - Pricing and Benefit Updates Form and Instruction Removed
192729 Issuers - Pricing and Benefit data Form and Instruction Removed
192728 Issuers - Basic Information Submission Form and Instruction Removed
192727 Issuers - Training, reviewing regulation, and analyzing data Form and Instruction Removed
192726 States - Training, reviewing regulation, and analyzing data Form and Instruction Modified
192725 States - Data submission Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2012 36 Months From Approved 11/30/2011
5,550 0 31,690
86,625 0 101,958
0 0 0





Reginfo record details
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table that charts list of burden
IC Title Form No. Form Name
States - Data submission CMS-10320, CMS-10320 CMS-10320.FINAL State Instructions and Instrument (5-5-10). ,   Appendix_E_StateRequirements
States - Training, reviewing regulation, and analyzing data CMS-10320, CMS-10320 CMS-10320.FINAL State Instructions and Instrument (5-5-10). ,   Appendix_E_StateRequirements
States - Data Collection CMS-10320, CMS-10320 Appendix_E_StateRequirements ,   CMS-10320.FINAL State Instructions and Instrument
Issuers - Submission Preparation (Individual) CMS-10320, CMS-10320, CMS-10320 Appendix_C_InsuranceIssuers2 ,   Appendix_D_BenefitsPremiumsInformation2 ,   CMS-10320.Issuer - FINAL Instructions and Instruments
Issuers - Submission Preparation (Small Group) CMS-10320, CMS-10320, CMS-10320 Appendix_C_InsuranceIssuers2 ,   Appendix_D_BenefitsPremiumsInformation2 ,   CMS-10320.Issuer - FINAL Instructions and Instruments
Issuer - Data Entry (Individual) CMS-10320, CMS-10320, CMS-10320 Appendix_D_BenefitsPremiumsInformation2 ,   Appendix_C_InsuranceIssuers2 ,   CMS-10320.Issuer - FINAL Instructions and Instruments
Issuer - Data Entry (Small Group) CMS-10320, CMS-10320, CMS-10320 Appendix_D_BenefitsPremiumsInformation2 ,   Appendix_C_InsuranceIssuers2 ,   CMS-10320.Issuer - FINAL Instructions and Instruments
Issuers Training and Communication CMS-10320, CMS-10320, CMS-10320 Appendix_C_InsuranceIssuers2 ,   Appendix_D_BenefitsPremiumsInformation2 ,   CMS-10320.Issuer - FINAL Instructions and Instruments
Issuer - Troubleshoot (Individual) CMS-10320, CMS-10320, CMS-10320 Appendix_D_BenefitsPremiumsInformation2 ,   Appendix_C_InsuranceIssuers2 ,   CMS-10320.Issuer - FINAL Instructions and Instruments
Issuer - Troubleshoot (Small Group) CMS-10320, CMS-10320, CMS-10320 Appendix_D_BenefitsPremiumsInformation2 ,   Appendix_C_InsuranceIssuers2 ,   CMS-10320.Issuer - FINAL Instructions and Instruments
Issuer - Attest (Individual) CMS-10320, CMS-10320, CMS-10320 Appendix_C_InsuranceIssuers2 ,   Appendix_D_BenefitsPremiumsInformation2 ,   CMS-10320.Issuer - FINAL Instructions and Instruments
Issuer - Attest (Small Group) CMS-10320, CMS-10320, CMS-10320 Appendix_C_InsuranceIssuers2 ,   Appendix_D_BenefitsPremiumsInformation2 ,   CMS-10320.Issuer - FINAL Instructions and Instruments
Issuers - Training, reviewing regulation, and analyzing data CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments (5-12-10).
Issuers - Basic Information Submission CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments (5-12-10).
Issuers - Pricing and Benefit data CMS-10320 CMS-10320.Deliberative Document
Issuers - Pricing and Benefit Updates CMS-10320 CMS-10320.Deliberative Document
Premium Estimation Process CMS-10320 CMS-10320.Deliberative Document
Query Writing and Record Processing CMS-10320 CMS-10320.Deliberative Document

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 5,550 31,690 0 -26,140 0 0
Annual Time Burden (Hours) 86,625 101,958 0 -15,333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
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