Health Plan Identifier, Other Entity Identifier, and Change to National Provider Identifier Requirements

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10423 Supporting Statement Part A.docx	Supporting Statement A	Uploaded 2012-09-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204281	Health Plan Identifier, Other Entity Identifier, National Provider Identifier Application		New
202161	Government		Removed
202160	Private Sector		Removed
202159	Individuals		Removed

ICR Details

OMB Control No: 0938-1166	ICR Reference No: 201209-0938-009
Status: Historical Active	Previous ICR Reference No: 201205-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Health Plan Identifier, Other Entity Identifier, and Change to National Provider Identifier Requirements
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: Approved without change	Conclusion Date: 05/15/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/26/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2016	36 Months From Approved
Responses	175,000	0	0
Time Burden (Hours)	60,300	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This collection is needed to fulfill section 1104 of the Affordable Care Act, which calls for Secretary to establish a unique health plan identifier. The Secretary will assign a health plan identifier and other entity identifier and needs to collect information about these entities when assigning an identifier.

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Authorizing Statute(s): US Code: 42 USC 1320d-2 Name of Law: Standards to Enable Electronic Exchange
  

Citations for New Statutory Requirements: US Code: 42 USC 1320d-2 Name of Law: Standards to Enable Electronic Exchange

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AQ13	Final or interim final rulemaking	77 FR 54664	09/05/2012

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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: 1

table that charts list of burden

IC Title	Form No.	Form Name
Government
Health Plan Identifier, Other Entity Identifier, National Provider Identifier Application
Individuals
Private Sector

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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	175,000	0	160,000	15,000	0	0
Annual Time Burden (Hours)	60,300	0	52,800	7,500	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: This is a new information collection request.

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Annual Cost to Federal Government: $1,574,872

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: 09/25/2012

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