Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges

ICR 201211-0938-003

OMB: 0938-1172

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2012-11-15
Supporting Statement A
2012-11-15
IC Document Collections
IC ID
Document
Title
Status
202391 Modified
ICR Details
0938-1172 201211-0938-003
Historical Active 201211-0938-001
HHS/CMS
Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 11/15/2012
Retrieve Notice of Action (NOA) 11/15/2012
  Inventory as of this Action Requested Previously Approved
08/31/2015 08/31/2015 08/31/2015
56 0 56
11,816 0 11,816
0 0 0

CMS is working with States (including the District of Columbia and the territories) to establish Exchanges in every State. The law gives States the opportunity to establish State-based Exchanges, subject to approval that the State-based Exchange meets federal standards and will be ready to offer health care coverage on January 1, 2014. The deadline for Exchange approval is January 1, 2013. In a State that does not achieve Exchange approval by the deadline, the law directs the Secretary of Health and Human Services to facilitate the establishment of an Exchange in that State. States will apply for approval or conditional approval of their State Exchange in the Fall of 2012 with decisions made on January 1, 2013.

PL: Pub.L. 111 - 148 1311(b) Name of Law: Affordable Care Act
  
None

Not associated with rulemaking

Yes

1
IC Title Form No. Form Name
Exchange Blueprint CMS-10416 Exchange Blueprint

  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 56 56 0 0 0 0
Annual Time Burden (Hours) 11,816 11,816 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
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.
11/15/2012


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