CMS-10408_Subsequent_Email_Clean_Sponsor_Did_Not_Previously_Respond_FINAL

Dear Authorized Representative,
As the Authorized Representative for a Plan Sponsor that has received reimbursement under the Early Retiree
Reinsurance Program (ERRP) for Application ID [PREPOPULATE APPLICATION ID HERE], the Centers for
Medicare & Medicaid Services (CMS) requests that you complete a survey that is primarily related to determining
how a Plan Sponsor has used or intends to use ERRP reimbursements. If necessary, another appropriate individual
may complete the survey on your behalf.
The ERRP statute at 42 U.S.C. §18002(c)(4) limits the permissible uses of ERRP proceeds, as follows:
(4) USE OF PAYMENTS - Amounts paid to a participating employment-based plan under this subsection shall
be used to lower costs for the plan. Such payments may be used to reduce premium costs for an entity
described in subsection (a)(2)(B)(i) or to reduce premium contributions, copayments, deductibles, coinsurance,
or other out of pocket costs for plan participants. Such payments shall not be used as general revenues for an
entity described in subsection (a)(2)(B)(i).
That subparagraph also states:
The Secretary shall develop a mechanism to monitor the appropriate use of such payments by such entities.
As part of the Secretary's efforts to monitor the appropriate use of such payments, the Secretary is asking ERRP Plan
Sponsors that have received ERRP funds to respond to a survey that asks detailed questions about how they have
used or intend to use ERRP funds, and the timing of when they have or will use such funds. This survey also asks
questions about certain decisions the Sponsor has or will make with regard to coverage.
The purpose of this survey is to understand better how Plan Sponsors participating in the ERRP are utilizing program
funds. CMS may release the results publicly, but will not attribute any response to a particular Sponsor. All results
will be reported in aggregate. Sponsors should note, however, that the results of this survey are subject to the
Freedom of Information Act.
We do not expect that all answers to the survey are or will prove to be 100% accurate. However, sponsors that
respond to the survey should answer all questions as accurately and completely as possible. We ask that you please
provide your response within 30 days.
A relatively few number of Plan Sponsors have received ERRP reimbursement for more than one plan (i.e. for more
than one ERRP application). Authorized Representatives of such Plan Sponsors are asked to complete one survey
for each such plan, if applicable (i.e. for each such ERRP application). Please provide only one survey per ERRP
application.
Please access the survey at LINK. If you have any questions about the survey, or need additional information,
please contact the ERRP Center at [email protected] or toll-free at 1-877-574-3777. The ERRP Center is available
Monday through Friday between 10:30AM - 7:00PM, ET. We encourage you to regularly monitor the ERRP website
at http://www.errp.gov for updated program information.
CMS thanks you in advance for completing the survey. Please complete the survey as soon as possible.

PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this
information collection is 0938-1150. The time required to complete this information collection is
estimated to average 11 hours per response, including the time to review instructions, search existing data
resources, gather the data needed, and complete and review the information collection. If you have
comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please
write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05,
Baltimore, Maryland 21244-1850. Form Number: CMS-10408