CMS-10333 Supporting statement 2013 PRA 2113 FINAL (1)

Supporting Statement – Part A
Supporting Statement for Paperwork Reduction Act Submissions
A. Background
On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act. On
March 30, 2010, the Health Care and Education Reconciliation Act of 2010 was also signed into law. The
two laws collectively are referred to as the Affordable Care Act (ACA). Section 1002 of the ACA added
section 2793 of the Public Health Service Act, which provides for grants to States to establish, expand, or
provide support for, independent offices of health insurance consumer assistance or ombudsman programs,
starting in FY 2010. For FY 2010, $30 million was appropriated to help States and Territories establish or
enhance these activities, which we refer to here as Consumer Assistance Program (CAP) activities.
Consumer assistance or ombudsman programs assist consumers with filing complaints and appeals, and
enrolling in health coverage. They also educate consumers on their rights and responsibilities. In addition,
as a condition of receiving a grant, states must provide for CAPs to collect data on consumer inquiries and
complaints to identify problems in the marketplace and strengthen enforcement. With the establishment of
the new Exchange marketplaces, programs must also help consumers resolve problems with obtaining
premium tax credits for Exchange coverage.
It is the priority of the consumer assistance program grants to increase CAPs’ ability to fulfill these duties.
As health reform continues to be implemented, consumers will need to understand new programs, avail
themselves of new protections, and navigate the system to find the most affordable and secure coverage that
meets their needs. Consumer assistance programs will be expected to provide the range of assistance
services required by law, not only with respect to private health insurance and group health plans, but for
high-risk pools and the new Pre-existing Condition Insurance Plan as well. At the outset, programs will not
be expected to provide assistance related to the Medicaid and CHIP programs (titles XIX and XXI of the
Social Security Act), but will be required to demonstrate that they can and do make appropriate referrals for
such inquiries.
The ACA requires as a condition of receiving a grant that states ensure that CAPs report certain data to the
Secretary of Health and Human Services (HHS) in order to strengthen oversight. Programs must report on
the types of problems and questions consumers experience with health coverage, and how these are resolved.
Reports will help identify patterns of problems and suspected noncompliance as well as best practices. HHS
will share data reports with the U.S. Departments of Labor and Treasury, and with State regulators. Within
HHS, reports can also provide the Center for Consumer Information and Insurance Oversight (CCIIO) one
indication of the effectiveness of State enforcement, affording opportunities to provide technical assistance
and support to State insurance regulators and informing the need for further federal investigation.
The Consumer Support Group, an office within CCIIO, provides significant support services for CAPs,
including data reporting software and technical support, resource and training materials, and assistance on
casework as it relates to questions arising from Federal law.
All States and Territories are eligible for the consumer assistance program grants. In order to receive a
grant, applicants must propose a plan to use grant funds to develop or enhance their consumer assistance
activities and demonstrate that eligibility criteria are satisfied.

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B. Justification
1.

Need and Legal Basis

Section 1002 of the Affordable Care Act added section 2793 of the Public Health Service Act, which
provides for grants to States to establish, expand, or provide support for consumer assistance (or
ombudsman) programs, starting in FY 2010.
In order to strengthen oversight, the law requires programs that receive grant funds to report data to the
Secretary of the Department of Health and Human Services (HHS): “As a condition of receiving a grant
under subsection (a), an office of health insurance consumer assistance or ombudsman program shall be
required to collect and report data to the Secretary on the types of problems and inquiries encountered by
consumers” (Sec. 2793 (d)).
Analysis of this data reporting will help identify patterns of practice in the insurance marketplaces and
uncover suspected patterns of noncompliance. The law provides that HHS must use the data to determine
where more enforcement is needed, and must share program data reports with the Departments of Labor and
Treasury, and State regulators. Program data also can offer CCIIO one indication of the effectiveness of
State enforcement, affording opportunities to provide technical assistance and support to State insurance
regulators and, in extreme cases, inform the need to trigger federal enforcement.

2.

Information Users

Pursuant to section 2793(d) of the Public Health Service Act (PHSA), as added by Section 1002 of the
ACA, as a condition for receiving a consumer assistance program grant, states must provide that CAPs will
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. The statute
specifies that the Secretary of HHS will use the data for oversight, and will share these reports with the
Department of Labor and Treasury, and with State insurance regulators for use in enforcement.

3.

Use of Information Technology

A CAP is required as a condition of the grant to use some type of Database software to track all cases
received by the CAP. All casework must be entered into the Database. The Database must be able to keep
track of all caller information, such as caller demographics, type of coverage, problem type, and case
resolution. The Database must also track cases that the CAP referred to the Federal and State regulators,
Medicaid, CHIP, and other public programs.
Currently, many existing CAPs track cases they handle using Database software that predated the availability
of the CAP grants. If their Database software can generate the types of information required to be reported
to HHS, then the CAPs may continue to use their own Database software. However, CAPs, at their
discretion, may choose to use the CCIIO-provided database, or the State-Based System (SBS) offered by the
National Association of Insurance Commissioners (NAIC).
The CCIIO-provided database allows CAPs to collect and track casework and required data elements. As of
October 2011, the Database has been used successfully to generate data collection reports required by

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CCIIO. Templates for reporting will also be provided for use by CAPs that choose not to use the CCIIO
database. Data collection reports sent to CCIIO will not contain personally identifiable information.
We anticipate that the CCIIO-provided Database will alleviate some reporting pitfalls that have been
identified in other Database software used by CAPs. Accordingly, providing CAPs access to Database
software developed specifically to satisfy the requirements under this grants program will reduce any
reporting burdens. See Appendix 1, Screenshots of CCIIO-developed Database.

Government Paperwork Elimination Act (GPEA)
Is this collection currently available for completion electronically?



Yes, CAPs are required to send reports to HHS electronically. Reports are uploaded to a secure
government website.

Does this collection require a signature from the respondent(s)?



CAP grantees submit reports using a password-protected account through which they can only
submit reports on behalf of their CAP. This process was put into place to help ensure that the
submission is made only by the person authorized to submit reports on behalf of the CAP grantee.
As an additional method of report verification, HHS follows up with each respondent by phone to
verbally ensure that the information received through a report submission was the information the
respondent intended to submit.

If CMS had the capability of accepting electronic signature(s), could this collection be made available
electronically?



Not applicable since we will not require an e-signature.

If this collection isn’t currently electronic but will be made electronic in the future, please give a date (month &
year) as to when this will be available electronically and explain why it can’t be done sooner.



Not applicable.

If this collection cannot be made electronic or if it isn’t cost beneficial to make it electronic, please explain.



4.

Not applicable since the collection is made available electronically.

Duplication of Efforts
This information collection does not duplicate any other effort and the information cannot be obtained
from any other source.

5.

Small Businesses
Not applicable since these are grants to States.

6.

Less Frequent Collection
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Many CAPs receive hundreds, if not thousands, of calls from consumers per month. Close monitoring,
through data collection reports, of the nature of these calls will help identify patterns of problems and
suspected noncompliance as they occur. Accordingly, this will provide early indication of the
effectiveness of State enforcement, affording immediate opportunities to provide technical assistance
and support to State insurance regulators and informing the need for further federal investigation. We
believe that quarterly collection of this information is the minimum necessary to achieve these goals.
HHS will be in close contact with CAPs. Upon request by CAPs, HHS may allow less frequent
reporting due to burden on program activities.

7.

Special Circumstances
Explain any special circumstances that would cause an information collection to be conducted in a manner:
Requiring respondents to report information to the agency more often than quarterly;



If States report specific findings, the Secretary may require a more focused report to study the nature
of these findings.

Requiring respondents to prepare a written response to a collection of information in fewer than 30 days after
receipt of it;



If States report specific findings, the Secretary may require a more focused report to study the nature
of these findings.

Requiring respondents to submit more than an original and two copies of any document;



Not applicable. We will not require more copies than an original and two copies of any document.

Requiring respondents to retain records, other than health, medical, government contract, grant-in-aid, or tax
records for more than three years;



The data collected by CAP grantees (respondents) is owned by the respondents. They are free to
retain records beyond 3 years if they so choose, but are not required by PHS Act Section 2793 to do
so.

In connection with a statistical survey that is not designed to produce valid and reliable results that can be
generalized to the universe of study;



Not applicable. Statistical surveys are not contemplated for this program. The complaints statistics
that arise from this program are not generalizable, but will generate important information for
regulators as they engage in oversight of the private health insurance market.

Requiring the use of a statistical data classification that has not been reviewed and approved by OMB;



Not applicable. Statistical surveys are not contemplated for this program. The complaints statistics

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that arise from this program are not generalizable, but will generate important information for
regulators as they engage in oversight of the private health insurance market.
That includes a pledge of confidentiality that is not supported by authority established in statue or regulation
that is not supported by disclosure and data security policies that are consistent with the pledge, or which
unnecessarily impedes sharing of data with other agencies for compatible confidential use; or



Not applicable. The data collection authority and sharing of reports with the Departments of Labor
and Treasury and with State regulators is in the statute. PHSA §2793(d), as added by section 1002
of ACA.

Requiring respondents to submit proprietary trade secret, or other confidential information unless the agency
can demonstrate that it has instituted procedures to protect the information's confidentiality to the extent
permitted by law.



8.

Not applicable. This is outside the scope of our reporting requirements.

Federal Register/Outside Consultation
Describe efforts to consult with persons outside the agency to obtain their views on the availability of data,
frequency of collection, the clarity of instructions and recordkeeping, disclosure, or reporting format (if any),
and on the data elements to be recorded, disclosed, or reported.



The Consumer Support Group has engaged in discussions with several consumer assistance
programs that existed before the availability of CAP funds, and with one organization that, in the
past, has conducted nationwide research on such programs. From this inquiry, we learned that
consumer assistance programs regularly compile reports for various audiences (i.e. state insurance
departments, state legislature, general public, etc.). Some of the information required in the data
collection report are already collected by these programs and are reported to different agencies on
either a quarterly or semi-annual basis. Other information required by CCIIO may already be
collected as well; however it may be in a format that is not countable and reportable. For example, a
few of the existing programs we’ve spoken to capture demographic information (i.e. age and
income) in the case notes as opposed to an independent data field, thus making it impossible to
generate a counting report on the average age or income of consumers calling with a health
insurance problem.



Comments received and responded to following the publication of the 2011 3-year CAP PRA
resulted in further enhancements to the data collection software that CCIIO provided to CAPs in the
areas of appeals and recovered benefits, grandfathered plans, and statements by consumers who
benefitted from contacting CAPs.



In an effort to further enhance reporting by CAPs, the Health Insurance Resource Specialists
(Specialists) within the Consumer Support Group provided a number of CAP grantees the
opportunity to test new reporting tools and templates and to provide feedback. This is an ongoing
effort that is implemented by the Consumer Support Group to ensure that new reporting tools and
templates are beneficial and are less burdensome to CAP grantees.



The 60-day Federal Register notice published on July 27, 2012 and expired September 25, 2012.
Received a total of 21 comments from the following four organizations: FamiliesUSA; Community

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Service Society; Consumers for Affordable Health Care; and Vermont Legal Aid, Inc., Office of
Health Care Ombudsman. All comments were summarized, consolidated (where overlap existed),
and addressed in the attached document.
The majority of comments involved feedback on providing CAPs with more flexibility in collecting
and reporting data. The implementation of a new progress report will allow CAPs to provide more
information about their progress and activities.
In addition, CMS received comments suggesting that collection of all of the CMS-required data
elements is difficult and that adjustments to pre-existing databases is too expensive and laborious.
CMS recognizes these concerns and acknowledges that CAPs are in the best situation to determine
the level of information that is able to be collected for any given consumer.
CMS also received comments suggesting that CMS provide guidance to CAPs on how to accurately
measure savings to consumers. CMS has provided CAPs with suggestions on ways to calculate
recovered benefits and will explore whether more comprehensive guidance is necessary.
Consultation with representatives of those from whom information is to be obtained or those who must
compile records should occur at least once every 3 years - even if the collection of information activity is the
same as in prior periods. There may be circumstances that may preclude consultation in a specific situation.
These circumstances should be explained.

Under this grant, ongoing technical support will be provided to CAPs through the Specialists.
Specialists provide direct training and support to grantees as they implement their programs. Specialists
conduct information sharing conference calls; conduct training programs on federal law including the
ACA; instruct CAPs in how to conduct consumer assistance casework; troubleshoot and assist with
difficult consumer cases as necessary; and collect, track, and analyze data on consumer inquiries and
complaints to help the Secretary identify problems in the marketplace and strengthen enforcement.
CMS prepares educational materials about consumer protections in the Affordable Care Act for the
public at large, to be made available on HealthCare.gov, through the State Consumer Assistance
Programs, and in future, through partnerships with consumer advocates and other stakeholder groups.
This group will also be working with the CAPs and stakeholder groups to broaden consumer awareness
of the CAP programs and the Affordable Care Act through a variety of means and media. Among the
range of resources under consideration: providing speakers for stakeholder group meetings, producing
short, instructional web videos.
The Consumer Support Group provides technical assistance on non-routine questions about the
Affordable Care Act, particularly the Affordable Care Act’s interaction with the law of a particular
state. The team does legal research, develops resource materials for the staff of the Consumer Support
Group as well as the staffs of state grantees, and assists in responding directly to consumer inquiries as
requested.

9.

Payments/Gifts to Respondents


Not applicable. We will not provide any payments or gifts.

10. Confidentiality
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Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute,
regulation, or agency policy.



The Consumer Support Group does not collect personally identifiable information from consumer
assistance program awardees. Data collection reports required by the Consumer Support Group
include summaries of aggregate data on the types of problems and questions consumer experience
with health coverage, how these are addressed, and how these are resolved.

11. Sensitive Questions
Provide additional justification for any questions of a sensitive nature, such as sexual behavior and attitudes,
religious beliefs, and other matters that we commonly considered private. This justification should include
the reasons why the agency considers the questions necessary, the specific use of the information, the
explanation to be given to persons from whom the information is requested, and any steps to be taken to
obtain their consent.



12.
I.

In order to conduct health insurance consumer assistance, CAPs may frequently need to ask clients
information about their health status, income, employment status, citizenship and other
characteristics that people might commonly consider private. Personally identifiable information
will be used only to assist a client or with their permission to refer them to other assistance, but will
never be forwarded to HHS. Awardees provide HHS with aggregated data on consumer problems
broken down by client characteristics.

Burden Estimates (Hours & Wages)
APPLICATION
This is already captured in SF424 authority to collect information based on funding opportunity
announcement requirements. (OMB#: 4040-0004)

II. DATA COLLECTION REPORTING
A. Data collected and reported
All the data elements enumerated in the CCIIO-developed database would not be collected in every case.
HHS expects grantees to collect information that is relevant to the specific case under consideration. See
Appendix 1, Screenshots of CCIIO-developed Database.
In the first year of CAP operations, grantees submitted aggregate data to CCIIO through the Health
Information Oversight System (HIOS) three times: six months after the date of the FY 2010 award and
quarterly thereafter. The Specialists downloaded the data submitted by grantees and analyzed it for
classification. Following this analysis, Specialists transmitted a summary of the data to the grantees, who
confirmed its accuracy.
Moving forward, the format of data reporting will also include four quarterly progress reports and an annual,
end-of-year text document in addition to the quarterly data collection reports submitted through HIOS. See
Appendix 2, Template for the Quarterly Progress Report. See also Appendix 3, Template for the Annual
Report. The information to be collected for quarterly reports will be the following:

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Contact Information
CAPs will collect contact information for the consumer, so that the program may contact the consumer with
any necessary follow-up information. The consumer’s English proficiency and any third party information
will also be collected in order best serve consumers who may have difficulty communicating. Although any
personally identifiable information will not be reported, CAPs will report data on English proficiency of the
consumers they serve.
Caseload
CAPs will report on the number of consumer complaints and inquiries handled by the program. Programs
will report on the status of these cases, such as the number of cases that are currently ongoing and cases that
have been closed. The resolution of closed cases will also be reported as either problem resolved, no help
available, help available but inadequate, information only (no complaint or problem identified), or case
closed due to consumer unresponsiveness. Additionally, CAPs will report the number of consumers who are
insured, insured in transition, insured with other problem, uninsured and unable to re-contact at the
conclusion of each case.
Caller Demographics
CAPs will report the number of cases by demographic information. Demographic information will allow a
more complete understanding of the consumer’s health insurance problem. For example, collecting a
consumer’s employment status provides insight into the possibility of accessing employer-sponsored
insurance; and collecting household income and number in household can determine if a consumer might be
eligible for a low-income program through a federal program such as Medicaid or CHIP.
Insurance Status and Recent History
CAPs will report the number of cases reported by insurance status. Insurance status is defined as Uninsured,
Insured in Transition, and Insured with Other Problem. Because access to health insurance options can
differ based on health insurance status and health insurance history of the consumer it is important to collect
the following information about the consumer to adequately identify insurance options that may be available:
Uninsured:
 length of uninsurance
 type of coverage last had, and
 reason(s) for coverage loss
Insured, In-Transition:
 type of coverage at initial contact
 whether the consumer is the primary insured or dependent of the primary insured, and
 the reason(s) for anticipated coverage loss
Insured with Other Problem:
 type of coverage at initial contact,
 whether the consumer is the primary insured or dependent of the primary insured, and
 the problem(s) with current coverage

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In every case, the name of the employer plan, issuer, and/or third party administrator must be captured.
Whether the plan is fully-insured, self-insured or self-insured non-governmental plan must also be collected.
This information will enable the caseworker to identify the entities that may have to be contacted to help
resolve the consumer complaint, and where compliance to federal and state laws is an issue, be able to
contact the appropriate agency that has jurisdiction over enforcement of such laws.
Health Insurance Options
CAPs will report on health insurance options identified for consumers who called the program, and whether
the options identified were obtained when needed, and if so, whether they were obtained with associated
burdens, such as affordability of premium and inadequacy of coverage due to a pre-existing condition
exclusion. If health insurance options were not obtained when needed, CAPs will report the reasons why
coverage was not obtained. These may be due to ineligibility, waiting periods, imposition of pre-existing
exclusion periods, denial, excessive premiums, just to name a few.
Affordable Care Act
CAPs will report the number of cases involving ACA-related questions, as well as the number of cases
involving ACA compliance or violation. Accordingly, CAPs will need to determine, and be able to report
which of these plans are grandfathered plans. In every case, CAPs must report the type of ACA issue:
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Early Retiree Reinsurance Program (ERRP)
Dependent coverage to age 26
Rescission
Annual benefit maximum (including mini med plans)
Lifetime benefit maximum
Out-of-network emergency care
PCP/Pediatrician choice
OB/GYN access
Pre-existing condition exclusion and denial for children
Elimination of Pre-existing condition restrictions for adults
Pre-existing Condition Insurance Plan (PCIP)
HIPAA Opt-out by Self-Funded Non-Federal Government Plans
Appeals and grievances
Premium rate increase
CO-Ops
Essential Health Benefits
Summary of Benefits and Coverage (SBC)
Student Health Plans
Prevention Services
Medical loss ratio rebates (MLR)
Fair premium rating factors
Extension of guaranteed Issue to all Markets
Guaranteed Renewability in all Markets
Wellness programs
Waiting period of over 90-days
Coverage of Clinical Trials
Discrimination based on salary
Limitation on out-of-pocket cost and deductible

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

Shared responsibility payments (employer and employee)

In cases with ACA compliance or violation issues identified, CAPs must collect and report the different
agencies that they have contacted for enforcement action, as well as the disposition of each of the contact to
determine if enforcement action was taken.
Appeals
CAPs will report the number of cases involving internal and external appeal. Along with reporting cases on
appeal, it is essential that CAPs collect and report detailed information on the type of denial, the reason for
the denial, the timeframe of the appeal (whether expedited or non-expedited), whether a fee is required for
an external appeal, and when the appeal is successful, the amount of recovered benefits.
In every appeals case, the name of the employer plan, issuer, and/or third party administrator must be
captured. Whether the plan is fully-insured, self-insured or self-insured non-governmental plan must also be
collected. This information will enable the caseworker to identify the entities that may have to be contacted
to help resolve the consumer complaint, and where compliance with federal and state laws is an issue, be
able to contact the appropriate agency that has jurisdiction over enforcement of such laws.
Outreach and Education
CAP grantees are encouraged to conduct outreach events and provide information to consumers in
innovative and comprehensive ways, ranging from distributing brochures to the public (often in multiple
languages), to more intensive outreach such as one-on-one counseling, and targeted outreach and
information to specific groups of consumers such as those who reside in counties with the highest percentage
of uninsured residents. Some CAP grantees convene larger events such as “town hall meetings” to educate
consumers on the services the grantee provides and new protections available under the ACA. Many
programs also use social media outlets to reach their communities.
CAPs also provide education on general health insurance inquiries or provide information to consumers on
how to contact the appropriate agency to help them resolve their problems. For example, Medicare or
Medicaid beneficiaries having problems with their public health coverage would be provided referrals to the
appropriate Medicaid or Medicare State Health Insurance Program (SHIP) office.
CAP grantees must report outreach and education efforts funded by CAP grants.
Exchange-Related Duties
CAP grantees may use the funds they receive to carry out duties that assist consumers seeking coverage
through an Exchange. These duties must be within the scope of the five specific categories of duties as
described in Section 2793(c). With the establishment of the Exchange marketplaces, programs must assist
consumers by answering general questions about Exchanges; referring consumers to other consumer
assistance programs (e.g., navigators); assisting with obtaining premium tax credits, and assisting with
eligibility and enrollment in coverage sold in the Exchange.
Other Assistance Referred
CAPs will report the number of cases that were referred to another agency because they were beyond the
scope of the program, such as Medicaid, CHIP, Medicare (SHIP), VA, and TRICARE.

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Culturally and Linguistically Appropriate Services (CLAS)
CAPs reporting data to CCIIO shall demonstrate their ability to communicate effectively with consumers,
including how they will provide services to those with limited English proficiency including, but not limited
to, interpretive services and translation of materials about health insurance coverage. CAPs are also required
to identify personnel who have the ability to provide assistance that is culturally and linguistically
appropriate, in accordance with the guidelines on the Office of Minority health’s website
(http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15) for the national standards on
culturally and linguistically appropriate services.
Examples of compliance with this requirement include the publication of brochures and other materials in
languages of the prevalent non-English speaking population(s), and the use of language lines for real-time
translation needs.
See Appendix 3 for an example of how compliance with the CLAS requirement will be reported to CCIIO
on the Annual Reporting form.
B. Cost and Burden to Grantees
The Consumer Support Group makes the following assumptions about cost and burden to new CAP grantees
associated with data collection and reporting:
Type of Personnel

1

Wage per hour

Mid-Level Professional – GS-12 equivalent
Mid-Level IT Professional – GS-12 equivalent
Senior Executive Professional – GS 15 equivalent

$29
$29
$48

1. Initial Set-up of Database
The cost burden associated with the initial set up of the database will only apply to grantees that have never
applied for CAP grants.
Data will be collected and reported by a mid-level professional at an hourly rate of approximately $29 per
hour. The mid-level professional will devote 16 hours to the initial submission. A mid-level IT professional
will spend 4 hours implementing the database system. A senior executive will devote 8 hours to overseeing
the initial submission, including reviewing the system to ensure its readiness, SOPs, ensure training of the
mid-level professional.
Hours: 16 hours + 4 hours + 8 hours = 28 hours
Costs: 16 hours x $29 = $464
4 hours x $29 = $116
8 hours x $48 = $384
Total for Initial Set-up: $464 + $116 + $328 = $964
2. Quarterly Submissions
1

Source: Office of Personnel Management, 2012 General Schedule (GS) http://www.opm.gov/oca/12tables/pdf/gs_h.pdf

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Data collection reports
The cost burden associated with the quarterly Data Collection Reports will apply to all CAP grantees. There
will be four quarterly reports. CCIIO estimates that a mid-level professional will take up to 24 hours to
compile the report. A senior level executive will take up to 5 hours to review and grant clearance to the
report. For CAP grantees that use the CCIIO-developed database, CCIIO estimates that a mid-level
professional will take up to 2 hours to compile the report and a senior level executive will take up to 1 hour
to review and grant clearance to the report.
CCIIO Database User:
Hours: 2 hours (mid-level time) x 4 (four quarterly submissions) + 1
hour (senior level professional time) x 4 (four quarterly submissions) = 12 hours
Costs: 8 hours x $29 (mid-level wage rate) = $232
4 hours x $48 (senior staff wage rate) = $192
Total for Quarterly Data Collection Reports (CCIIO Database User): $424
Non-CCIIO Database User:
Hours: 24 hours (mid-level time) x 4 (four quarterly submissions) + 5 hour (senior level
professional time) x 4 (four quarterly submissions) = 116 hours
Costs: 96 hours x $29 (mid-level wage rate) = $2784
20 hours x $48 (senior staff wage rate) = $960
Total for Quarterly Data Collection Reports (Non-CCIIO Database User): $3744
Total for Quarterly Data Collection Reports: Ranging from $424 to $3744
Progress Report
The cost burden associated with the Quarterly Progress Reports will apply to all CAP grantees. There will be
four quarterly reports. CCIIO estimates that a mid-level professional will take 16 hours to draft and compile
the report. A senior level executive will take 2 hours to review and grant clearance to the report. See
Appendix 2, Template for the Quarterly Progress Report.
Hours: 16 hours (mid-level time) x 4 (four quarterly submissions) + 2 hours (senior level
professional time) x 4 (four quarterly submissions) = 72 hours
Costs: 64 hours x $29 (mid-level wage rate) = $1856
8 hours x $48 (senior staff wage rate) = $384
Total for Quarterly Progress Reports: $1856 + $384 = $2240
Total for All Quarterly Submissions: Ranging from $2664 to $5984
3. Annual Report
Grantees’ reporting requirements include the submission of an Annual Report due within 90 days from the
end of the project/budget period. See Appendix 3, Template for the Annual Report.
Hours: 40 hours (mid-level staff wage rate) x 1 annual report + 5 hours (senior staff wage rate) x 1
annual report = 45 hours
Cost: 40 hours x $29 (mid-level wage rate) = $1160

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5 hours x $48 (senior staff wage rate) = $240
Total for Annual Report = $1160 + $240 = $1400
Total for All Submissions (Quarterly Submissions + Annual Report): Ranging from $4064 to $7384
Total Cost Burden to New Grantees (Database setup + Quarterly Submissions + Annual Report):
Ranging from $5028 to $8348
Total Cost Burden to Former Grantees (Quarterly Submissions + Annual Report): Ranging from
$4064 to $7384

Quarterly
Submissions
Annual Report
Total

# of
Respondents
56

Frequency

Responses
448

Annual
Burden Hours
84 - 216

8

56
56

1
9

Annual cost
$2664 - $5984

56
504

45
129 - 261

$1400
$4064 - $7384

13. Capital Costs
The grant announcement indicates that preference will be given to applicants with a proven track record of
consumer assistance and expertise in consumer education and problem resolution. Therefore, we do not
anticipate that programs will need additional capital or startup costs. Start-up programs that need capital or
start-up are not likely to apply for funding based on the limited funding available under this grant
opportunity.

14. Cost to Federal Government
I. APPLICATION
The review of the applications from states for consumer assistance grants will be initially performed inhouse by federal employees.2 A reviewing panel of outside experts will then be convened to evaluate
applications and assist in the selection process.
A. Application Review by Federal Employees
We anticipate that 56 states and territories will submit an application. Each application is a maximum of 10
pages, excluding supporting documentation. Each application will require one hour for an initial review.
Total staff time for review will be 56 hours. The applications will be reviewed by mid-level staff. CCIIO
assumes that all 56 eligible states/territories will apply.
Hours: 56 (applications/states and territories) x 1 hour (initial review) = 56 hours
Costs: 56 hours x $29 = $1344
Total for Application Review by Federal Employees: $1344
B. Outside Panel Review
2

Source: Office of Personnel Management, 2012 General Schedule (GS) Locality Pay,

http://www.opm.gov/oca/12tables/pdf/gs_h.pdf

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1. Identification of potential reviewers
Senior staff will have to identify a panel of outside reviewers. If there is a panel of ten, senior staff will take
about 2 hours to identify potential reviewers. Mid-level staff will make an estimated 40 calls to identify and
confirm participation with the 10 panelists. Each call will take 15 minutes.
Hours: 2 hours (senior level staff) + 40 (15-minute calls by mid-level staff, totaling 600
minutes or 10 hours) = 12 hours
Costs: 10 hours x $29 = $290
2 hours x $48 = $96
Total for Identification of Potential Reviewers = $386
2. Training Panel of Reviewers
Two senior level staff (one CCIIO and one CMS OAGM staff) will provide a one-hour training, via phone
conference call, to the selected panel of reviewers to go over the process, responsibilities and expectations.
Hours: 1 hour x 2 (senior level staff) = 2 hours
Costs: 2 hours x $48 = $96
Total for Training Panel of Reviewers = $96
3. Call with Chairperson
One senior level staff from CCIIO will discuss with the Chair of the panel of reviewers the review process,
CCIIO’s expectations and the Chair’s responsibilities. This will be a .5 hour call.
Hours: .5 hour x 1 (senior level staff) = .5 hours
Costs: .5 hour x $48 = $24
Total for Call with Chairperson = $24
4. Participation in the panel review
Outside subject matter experts will participate as panel experts to review applications. In addition, two
federal employees participate in the panel review (one CCIIO senior level staff and one CMS Office of
Acquisitions and Grants Management senior level staff) to answer questions from the panel of experts.
CCIIO assumes the review process will take two eight-hour days for a total of 16 hours.
Hours: 2 (senior level staff) x 16 hours (two 8-hour work days) = 32 hours
Costs: 32 (senior level staff) hours x $48 = $1536
Total for Federal Employee Participation in Panel Review: $1536
C. Follow-up
Some applications will require follow-up phone calls and other attempts to clarify information or seek
additional information. CCIIO estimates that 30 applications will require follow-up review. One mid-level
staff from CCIIO and one mid-level staff from OAGM will require one hour each for follow-up.
Hours: 30 (follow-up applications) x 1 hour (mid level CCIIO staff) + 1 hour (mid level

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OAGM staff) = 60 hours
Costs: 60 hours x $29 = $1740
Total for Follow-up: $1740
D. Award Announcement and Grantee Notification
Mid-level staff will be devoted to developing rollout materials (factsheets, FAQs, website language, press
release, etc.) and follow-up notifications to grantees. CCIIO assumes that developing rollout materials will
take 16 hours. A senior level staff will take two hours review these materials. Further, mid-level staff will
notify grantees of the award. This will take 30 minutes per grantee. CCIIO assumes that all eligible
states/territories will receive an award.
Development of rollout materials
Hours: 16 hours (mid-level staff) x 1 (development) + 2 hours (senior level staff) x 1
(development) = 18 hours
Costs: 16 hours x $29 = $464
2 hours x $48 = $96
Total for Award Announcement: $560
Grantee notification
Hours: 56 (# of grantees) x .5 hour = 28 hours
Costs: 28 hours x $29 = $812
Total for Grantee Notification: $812
Total for Award Announcement and Grantee Notification: $1372
Total Cost for Application Review: $1344 + $386 + $96 + $24 + $1536 + $1740 + $1372 = $6498

II. DATA COLLECTION REPORTING
The review of the data submitted by CAPs per question 12(II) will be reviewed in-house by federal
employees.
A. Costs of Review of Quarterly Data Submissions
Mid-level staff will be performing a review of the quarterly data submissions, which includes discussions
with the grantee about the data submitted. CCIIO assumes that it will take two hours to review each
quarterly Data Collection Report and one hour to review each quarterly Progress Report. A senior level staff
will take 2 hours to review the aggregate report each quarter. CCIIO further assumes that all 50 states, the
District of Columbia, and 5 territories are awarded grants and submit quarterly data.
Hours: 56 (Data Collection Reports) x 4 (submissions per budget year) x 2 hours (mid
level staff review) + 56 (Progress Reports) x 4 (submissions per budget year) x 1
hour (mid level staff review) + 4 (aggregate reports) x 2 hours (senior level staff) =
680 hours
Costs: 672 hours x $29 = $19,488
8 hours x $48 = $384
Total for Costs of Review of Quarterly Data Submissions: $19,872

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B. Costs of Review of Annual Reports
Mid-level staff will review annual report submissions from CAP grantees. CCIIO assumes that it will take 1
hour to review each annual report. CCIIO further assumes that all 50 states, the District of Columbia, and 5
territories are awarded grants and submit an annual report.
Hours: 56 (Annual Reports) x 1 (submission per budget year) x 1 hour (mid level staff
review) = 56 hours
Costs: 56 hours x $29 = $1624
Total for Costs of Review of Annual Reports: $1624
C. Development of CAP White Paper
Mid-level staff will draft a white paper for CCIIO leadership and the Secretary on CAP data and will use the
data to facilitate senior staff discussions, initiatives and projects. CCIIO assumes that the preparation of the
white paper will require 32 hours of mid-level staff time and 4 hours of senior level staff time for review.
Hours: 32 hours (mid-level staff) + 4 hours (senior level staff) = 36 hours
Costs: 32 hours x $29 (mid-level wage rate) = $928
4 hours x $48 (senior staff wage rate) = $192
Total for Development of CAP White Paper: $1120
D. Other Data-Related Projects
Additional staff time devoted to data-related projects and initiatives is difficult to estimate. Given the
importance of the data, mid-level staff may spend 80 additional hours per year on follow-up, data-related
projects and initiatives. Senior staff may spend 20 hours performing review and follow-up activities.
Hours: 80 hours (mid-level staff) + 20 hours (senior level staff) = 100 hours
Costs: 80 hours x $29 (mid-level wage rate) = $2320
20 hours x $48 (senior staff wage rate) = $960
Total for Other Data-Related Projects: $3280
Total Cost for Data Collection Reporting: $19,872 + $1624 +$1120 + $3280 = $25,896
Total Cost to the Federal Government (Application Review + Data Collection Reporting) = $32,394
Description
Application review by federal
employees
Outside panel review
Follow-up
Award announcement and grantee
notification
Costs of review of quarterly data
submissions
Costs of review of annual reports

Cost
$1,344
$2,042
$1,740
$1,372
$19,872
$1,624

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Development of CAP white paper
Other data-related projects
Total

$1,120
$3,280
$32,394

15. Changes to Burden
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-ofyear 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), and the annual cost burden will increase to $467,488 (from the originally
approved $190,000).

16. Publication/Tabulation Dates


By law, the Secretary of HHS is required to share data collection reports with the Departments of
Labor and Treasury and State insurance regulators to strengthen enforcement. Consumer Support
Group staff will convey reports to these regulatory entities and in so doing will highlight and
summarize key findings from these reports. In addition, in 2012, CMS released the CAP White
Paper based on data submitted by CAPs in their first year of operations (October 15, 2012 through
October 14, 2011). A PDF of the paper can be found here http://cciio.cms.gov/resources/files/csgcap-summary-white-paper.pdf.pdf.

17. Expiration Date


We expect that the Database software we provide to awardees will be used into the future. Note that
programs are authorized to continue permanently. CAP operations will continue so long as there is
continued funding.

18. Certification Statement


No exceptions apply.

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