In accordance with 5 CFR 1320, the information collection is approved. The agency is reminded that they must review and update their supporting statements with each request. If supporting statements have not been updates, OMB will improperly submit the collection. With this revision, CMS corrects an error to the prior submission that significantly overstated the number of responses.
Inventory as of this Action
Requested
Previously Approved
03/31/2015
36 Months From Approved
12/31/2013
83,333
0
399,999
59,833
0
233,999
0
0
0
An eligible individual who wishes to apply for health insurance coverage under the PCIP program must complete and submit an enrollment application. The enrollment application includes vital pieces of information used to verify the applicant is eligible for the PCIP program and enroll applicants deemed to be eligible. Individuals who have not had prior creditable coverage within the past 6 months, are a US Citizen or lawfully present, and have a pre-existing condition may apply for coverage under the PCIP program.
PL:
Pub.L. 111 - 148 1101
Name of Law: Immediate access to insurance for uninsured individuals with a preexisting condition.
PL:
Pub.L. 111 - 148 1101
Name of Law: Immediate access to insurance for uninsured individuals with a preexisting
The burden associated with this information collection request (ICR) has decreased by 233,999 hours. It has been identified as a program change because of the ROCIS system. It is an adjustment. The burden has been adjusted to correct an arithmetic error. When originally submitted, this ICR was quadruple counting the burden when instead the burden should only have been listed once as it was the estimated annual burden from year to year. The downward adjustment resulted in the correct estimated annual burden of 59,883 hours.
$20
No
No
Yes
No
No
Uncollected
William Parham 4107864669
No
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:
(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;
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.
Form CMS-10334 Premium Payment Burden
CMS-10334 Supporting_Statement_Part_A(CLEAN 1-30-12).docx
Premium Payment Burden