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 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction New Available
Form CMS-10320 Appendix_D_BenefitsPremiumsInformation2 Form and Instruction New Available
Form CMS-10320 Appendix_C_InsuranceIssuers2 Form and Instruction New Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction New Available
Form CMS-10320 Appendix_D_BenefitsPremiumsInformation2 Form and Instruction New Available
Form CMS-10320 Appendix_C_InsuranceIssuers2 Form and Instruction New Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction New Repair queued
Form CMS-10320 Appendix_C_InsuranceIssuers2 Form and Instruction New Available
Form CMS-10320 Appendix_D_BenefitsPremiumsInformation2 Form and Instruction New Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction New Available
Form CMS-10320 Appendix_C_InsuranceIssuers2 Form and Instruction New Available
Form CMS-10320 Appendix_D_BenefitsPremiumsInformation2 Form and Instruction New Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction New Available
Form CMS-10320 Appendix_C_InsuranceIssuers2 Form and Instruction New Available
Form CMS-10320 Appendix_D_BenefitsPremiumsInformation2 Form and Instruction New Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction New Available
Form CMS-10320 Appendix_C_InsuranceIssuers2 Form and Instruction New Available
Form CMS-10320 Appendix_D_BenefitsPremiumsInformation2 Form and Instruction New Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction New Available
Form CMS-10320 Appendix_D_BenefitsPremiumsInformation2 Form and Instruction New Available
Form CMS-10320 Appendix_C_InsuranceIssuers2 Form and Instruction New Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction New Available
Form CMS-10320 Appendix_D_BenefitsPremiumsInformation2 Form and Instruction New Available
Form CMS-10320 Appendix_C_InsuranceIssuers2 Form and Instruction New Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction New Available
Form CMS-10320 Appendix_D_BenefitsPremiumsInformation2 Form and Instruction New Repair queued
Form CMS-10320 Appendix_C_InsuranceIssuers2 Form and Instruction New Available
Form CMS-10320 CMS-10320.FINAL State Instructions and Instrument Form and Instruction New Available
Form CMS-10320 Appendix_E_StateRequirements Form and Instruction New Available
Form CMS-10320 CMS-10320.Deliberative Document Form and Instruction Removed Available
Form CMS-10320 CMS-10320.Deliberative Document Form and Instruction Removed Repair queued
Form CMS-10320 CMS-10320.Deliberative Document Form and Instruction Removed Available
Form CMS-10320 CMS-10320.Deliberative Document Form and Instruction Removed Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments (5-12-10). Form and Instruction Removed Repair queued
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments (5-12-10). Form and Instruction Removed Available
Form CMS-10320 Appendix_E_StateRequirements Form and Instruction Modified Available
Form CMS-10320 CMS-10320.FINAL State Instructions and Instrument (5-5-10). Form and Instruction Modified Available
Form CMS-10320 Appendix_E_StateRequirements Form and Instruction Modified Available
Form CMS-10320 CMS-10320.FINAL State Instructions and Instrument (5-5-10). 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 Available
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 NewCMS-10320.Issuer - FINAL Instructions and Instruments
199284 Issuer - Attest (Small Group) Form and Instruction NewAppendix_D_BenefitsPremiumsInformation2
199284 Issuer - Attest (Small Group) Form and Instruction NewAppendix_C_InsuranceIssuers2
199283 Issuer - Attest (Individual) Form and Instruction NewCMS-10320.Issuer - FINAL Instructions and Instruments
199283 Issuer - Attest (Individual) Form and Instruction NewAppendix_D_BenefitsPremiumsInformation2
199283 Issuer - Attest (Individual) Form and Instruction NewAppendix_C_InsuranceIssuers2
199282 Issuer - Troubleshoot (Small Group) Form and Instruction NewCMS-10320.Issuer - FINAL Instructions and Instruments
199282 Issuer - Troubleshoot (Small Group) Form and Instruction NewAppendix_C_InsuranceIssuers2
199282 Issuer - Troubleshoot (Small Group) Form and Instruction NewAppendix_D_BenefitsPremiumsInformation2
199281 Issuer - Troubleshoot (Individual) Form and Instruction NewCMS-10320.Issuer - FINAL Instructions and Instruments
199281 Issuer - Troubleshoot (Individual) Form and Instruction NewAppendix_C_InsuranceIssuers2
199281 Issuer - Troubleshoot (Individual) Form and Instruction NewAppendix_D_BenefitsPremiumsInformation2
199280 Issuer - Data Entry (Small Group) Form and Instruction NewCMS-10320.Issuer - FINAL Instructions and Instruments
199280 Issuer - Data Entry (Small Group) Form and Instruction NewAppendix_C_InsuranceIssuers2
199280 Issuer - Data Entry (Small Group) Form and Instruction NewAppendix_D_BenefitsPremiumsInformation2
199279 Issuer - Data Entry (Individual) Form and Instruction NewCMS-10320.Issuer - FINAL Instructions and Instruments
199279 Issuer - Data Entry (Individual) Form and Instruction NewAppendix_C_InsuranceIssuers2
199279 Issuer - Data Entry (Individual) Form and Instruction NewAppendix_D_BenefitsPremiumsInformation2
199278 Issuers - Submission Preparation (Small Group) Form and Instruction NewCMS-10320.Issuer - FINAL Instructions and Instruments
199278 Issuers - Submission Preparation (Small Group) Form and Instruction NewAppendix_D_BenefitsPremiumsInformation2
199278 Issuers - Submission Preparation (Small Group) Form and Instruction NewAppendix_C_InsuranceIssuers2
199277 Issuers - Submission Preparation (Individual) Form and Instruction NewCMS-10320.Issuer - FINAL Instructions and Instruments
199277 Issuers - Submission Preparation (Individual) Form and Instruction NewAppendix_D_BenefitsPremiumsInformation2
199277 Issuers - Submission Preparation (Individual) Form and Instruction NewAppendix_C_InsuranceIssuers2
199276 Issuers Training and Communication Form and Instruction NewCMS-10320.Issuer - FINAL Instructions and Instruments
199276 Issuers Training and Communication Form and Instruction NewAppendix_D_BenefitsPremiumsInformation2
199276 Issuers Training and Communication Form and Instruction NewAppendix_C_InsuranceIssuers2
199275 States - Data Collection Form and Instruction NewCMS-10320.FINAL State Instructions and Instrument
199275 States - Data Collection Form and Instruction NewAppendix_E_StateRequirements
194217 Query Writing and Record Processing Form and Instruction RemovedCMS-10320.Deliberative Document
194216 Premium Estimation Process Form and Instruction RemovedCMS-10320.Deliberative Document
192730 Issuers - Pricing and Benefit Updates Form and Instruction RemovedCMS-10320.Deliberative Document
192729 Issuers - Pricing and Benefit data Form and Instruction RemovedCMS-10320.Deliberative Document
192728 Issuers - Basic Information Submission Form and Instruction RemovedCMS-10320.Issuer - FINAL Instructions and Instruments (5-12-10).
192727 Issuers - Training, reviewing regulation, and analyzing data Form and Instruction RemovedCMS-10320.Issuer - FINAL Instructions and Instruments (5-12-10).
192726 States - Training, reviewing regulation, and analyzing data Form and Instruction ModifiedAppendix_E_StateRequirements
192726 States - Training, reviewing regulation, and analyzing data Form and Instruction ModifiedCMS-10320.FINAL State Instructions and Instrument (5-5-10).
192725 States - Data submission Form and Instruction ModifiedAppendix_E_StateRequirements
192725 States - Data submission Form and Instruction ModifiedCMS-10320.FINAL State Instructions and Instrument (5-5-10).

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
12
table that charts list of burden
IC Title Form No. Form Name
Issuer - Attest (Individual) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuer - Attest (Small Group) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuer - Data Entry (Individual) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuer - Data Entry (Small Group) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuer - Troubleshoot (Individual) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuer - Troubleshoot (Small Group) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuers - Basic Information Submission CMS-10320
Issuers - Pricing and Benefit Updates CMS-10320
Issuers - Pricing and Benefit data CMS-10320
Issuers - Submission Preparation (Individual) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuers - Submission Preparation (Small Group) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuers - Training, reviewing regulation, and analyzing data CMS-10320
Issuers Training and Communication CMS-10320, CMS-10320, CMS-10320 ,   ,  
Premium Estimation Process CMS-10320
Query Writing and Record Processing CMS-10320
States - Data submission CMS-10320, CMS-10320 ,  
States - Data Collection CMS-10320, CMS-10320 ,  
States - Training, reviewing regulation, and analyzing data CMS-10320, CMS-10320 ,  

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
  No