Consumer Assistance Program Grants

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10333 Appendix 2	Form and Instruction	Modified	Available
Form CMS-10333 Appendix 3	Form and Instruction	Modified	Available
Form CMS-10333 Appendix 1	Form and Instruction	Modified	Repair queued
CMS-10333 CMS Response to Public Comments.pdf	Supplementary Document	Uploaded 2012-12-11	Available
CMS-10333 Supporting statement 2013 PRA 2113 FINAL (1).pdf	Supporting Statement A	Uploaded 2013-02-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
193768	Data Collection Report (Quarterly and Annual Reports)	Form and Instruction	Modified	Appendix 2
193768	Data Collection Report (Quarterly and Annual Reports)	Form and Instruction	Modified	Appendix 3
193767	Data Collection Report (Initial Submission)	Form and Instruction	Modified	Appendix 1

ICR Details

OMB Control No: 0938-1097	ICR Reference No: 201212-0938-004
Status: Historical Active	Previous ICR Reference No: 201107-0938-017
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Consumer Assistance Program Grants
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/05/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/11/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	36 Months From Approved	09/30/2014
Responses	560	0	120
Time Burden (Hours)	16,184	0	4,800
Cost Burden (Dollars)	0	0	190,000

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Abstract: Pursuant to section 2793(d) of the Public Health Services Act (PHSA), as amended by Section 1002 of the ACA, as a condition for receiving the consumer assistance program grant, programs must collect and report data to the Secretary on the types of problems and inquiries encountered by consumers. Accordingly, program staff will need a system to maintain case files that will track these types of problems and inquiries. Problems and inquiries will be summarized and will be reported to HHS. By law, the user of the summary data is the Secretary of HHS and will be used for oversight. Further, ACA dictates that the Secretary will share these reports with the Department of Labor and Treasury, and with State insurance regulators for use in enforcement.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1002 Name of Law: Health Insurance Consumer Information
  

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:
	77 FR 44241	07/27/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 73033	12/07/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Data Collection Report (Initial Submission)	CMS-10333	Appendix 1
Data Collection Report (Quarterly and Annual Reports)	CMS-10333, CMS-10333	Appendix 3 ,   Appendix 2

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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	560	120	0	440	0	0
Annual Time Burden (Hours)	16,184	4,800	0	11,384	0	0
Annual Cost Burden (Dollars)	0	190,000	0	0	-190,000	0

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Due to additional reporting requirements, we anticipate there will be an increase in annual time burden and annual cost burden. The additional reporting includes four quarterly progress reports and an annual end-of-year report. Due to additional staff hours required to develop, collect, monitor, and review the new progress reports and annual report, we anticipate the annual time burden will increase to 16,184 hours (from the originally approved 4,800). CMS previously provided monetized burden hours as the "annual cost burden" -- but with this submission that error is corrected.

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Annual Cost to Federal Government: $32,394

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: 12/11/2012

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