Expedited Checklist: Medicaid Eligibility & Enrollment Systems - Advance Planning Document (E&E-APD ) (CMS-10385)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10385 Expedited Checklist: Medicaid Eligibility & Enrollment Information System(S) - Advance Planning Document (E&E - APD)	Form and Instruction	Modified	Available
CMS-10385 Supporting Statement part A [rev 10-06-11.doc	Supporting Statement A	Uploaded 2011-10-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
197257	Expedited Checklist: Medicaid Eligibility & Enrollment Systems - Advance Planning Document (E&E-APD) (CMS-10385)	Form and Instruction	Modified	Expedited Checklist: Medicaid Eligibility & Enrollment Information System(S) - Advance Planning Document (E&E - APD)

ICR Details

OMB Control No: 0938-1125	ICR Reference No: 201110-0938-003
Status: Historical Active	Previous ICR Reference No: 201104-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Expedited Checklist: Medicaid Eligibility & Enrollment Systems - Advance Planning Document (E&E-APD ) (CMS-10385)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/07/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/07/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2014	36 Months From Approved	11/30/2011
Responses	168	0	168
Time Burden (Hours)	840	0	840
Cost Burden (Dollars)	0	0	0

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Abstract: The Patient Protection and Affordable Care Act (the Affordable Care Act) applies new Medicaid eligibility and enrollment business rules for seamless coordination between the Medicaid and CHIP programs, and the Health Insurance Exchanges, known as "the Exchanges". In cases where the State's Medicaid Management Information System (MMIS), State's Eligibility System(s), or State's Exchange requires the support of system development and/or enhancement activities, States are eligible to receive FFP at the enhanced rate, if the system(s) will be designed and implemented to meet the seven standards and conditions. CMS has developed the Expedited Checklist: Medicaid Eligibility & Enrollment Information System(s) - Advance Planning Document (E&E-APD) specific to this purpose, for eligibility and enrollment system developments for State convenience.

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Authorizing Statute(s): US Code: 19 USC 1903(r) Name of Law: MMIS Section; FFP
   US Code: 19 USC 1903(a) and (b) Name of Law: MMIS Section; FFP
  

Citations for New Statutory Requirements: None

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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 41799	07/15/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 60843	09/30/2011
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
Expedited Checklist: Medicaid Eligibility & Enrollment Systems - Advance Planning Document (E&E-APD) (CMS-10385)	CMS-10385	Expedited Checklist: Medicaid Eligibility & Enrollment Information System(S) - Advance Planning Document (E&E - APD)

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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	168	168	0	0	0	0
Annual Time Burden (Hours)	840	840	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: $34,188

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]? No

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: 10/07/2011

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