Waivers for State Innovation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10383.Supporting Statement Part A.pdf	Supporting Statement A	Uploaded 2012-03-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
201391	State Public Notice Requirements (Tribal Notification) - (31 CFR 33.112 and 45 CFR 155.1312)		New
201390	State Reporting Requirements (Posting Annual Reports) - (31 CFR 33.124 and 45 CFR 155.1324)		New
201389	State Reporting Requirements (Annual) - (31 CFR 33.124 and 45 CFR 155.1324)		New
201388	State Reporting Requirements (Quarterly) - (31 CFR 33.124 and 45 CFR 155.1324)		New
201387	Monitoring and Compliance (31 CFR 33.120 and 45 CFR 155.1320)		New
201386	State Public Notice Requirements (31 CFR 33.112 and 45 CFR 155.1312)		New
201385	Application Procedures (31 CFR 33.108 and 45 CFR 155.1308)		New

ICR Details

OMB Control No:	ICR Reference No: 201203-0938-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Waivers for State Innovation
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 08/14/2012
	Date Received in OIRA: 03/02/2012
Terms of Clearance: CMS withdraws this collection to make additional edits to the ICR.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 1332 of the Affordable Care Act establishes authority for a 'Waiver for State Innovation'. Under this section, States can apply for a waiver, effective for plan years beginning on or after January 1, 2017, of the Affordable Care Act requirements relating to qualified health plans, Exchanges, cost-sharing reductions, premium tax credits, the individual responsibility requirement, and shared responsibility for employers. This information collection request covers this waiver process.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1332 Name of Law: Waiver for State innovation.
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1332 Name of Law: Waiver for State Innovation

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AQ75	Final or interim final rulemaking	77 FR 11700	02/27/2012

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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: 7

table that charts list of burden

IC Title	Form No.	Form Name
Application Procedures (31 CFR 33.108 and 45 CFR 155.1308)
State Public Notice Requirements (31 CFR 33.112 and 45 CFR 155.1312)
Monitoring and Compliance (31 CFR 33.120 and 45 CFR 155.1320)
State Reporting Requirements (Quarterly) - (31 CFR 33.124 and 45 CFR 155.1324)
State Reporting Requirements (Annual) - (31 CFR 33.124 and 45 CFR 155.1324)
State Reporting Requirements (Posting Annual Reports) - (31 CFR 33.124 and 45 CFR 155.1324)
State Public Notice Requirements (Tribal Notification) - (31 CFR 33.112 and 45 CFR 155.1312)

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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: This is a new information collection.

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Annual Cost to Federal Government: $0

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: 03/02/2012

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