Cycle I, II, and III - "Grants to Support States in Health Insurance Rate Review and Pricing Transparency" Reporting

Forms and Documents

Document Name	Status
Form CMS-10380 (Cycle III) Final Report Form and Instruction	New
Form CMS-10380 (Cycle III) Annual Report Form and Instruction	New
Form CMS-10380 (Cycle III) Transaction Data Collection Form and Instruction	New
Form CMS-10380 (Cycle III) Quarterly Report Form and Instruction	New
Form CMS-10380 (Cycle I) Final Report Form and Instruction	Modified
Form CMS-10380 (Cycle II ) Final Report - end of grant Form and Instruction	Modified
Form CMS-10380 (Cycle II) Annual Report Form and Instruction	Modified
Form CMS-10380 (Cycle II) Transaction Data Collection Form and Instruction	Modified
Form CMA-10380 (Cycle II) Quarterly Report Form and Instruction	Modified
Form CMS-10380 (Cycle II) Application Form and Instruction	Removed
Form CMS-10380 (Cycle I) Transaction Data Collection Form and Instruction	Modified
Form CMS-10380 (Cycle I) Quarterly Reports Form and Instruction	Modified
CMS-10380 - Crosswalk_ICR_for_Grants_to_States_for_Rate_Review.docx Supplementary Document	2013-08-06
CMS-10380 - Rate Review Grant Program Data Dictionary_0713.pdf Supplementary Document	2013-08-06
CMS-10380 - SupportingStatement_Part-A_CLEAN.pdf Supporting Statement A	2013-08-06

IC Document Collections

IC ID	Document Title	Status
208094	(Cycle III) Final Report Form and Instruction	New
208093	(Cycle III) Annual Report Form and Instruction	New
208092	(Cycle III) Transaction Data Collection Form and Instruction	New
208091	(Cycle III) Quarterly Report Form and Instruction	New
208090	(Cycle III) Application Other-Data	New
198639	(Cycle I) Final Report Form and Instruction	Modified
196347	(Cycle II ) Final Report - end of grant Form and Instruction	Modified
196346	(Cycle II) Annual Report Form and Instruction	Modified
196345	(Cycle II) Transaction Data Collection Form and Instruction	Modified
196344	(Cycle II) Quarterly Report Form and Instruction	Modified
196343	(Cycle II) Application Form and Instruction	Removed
196341	(Cycle I) Transaction Data Collection Form and Instruction	Modified
196340	(Cycle I) Quarterly Reports Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1121	ICR Reference No: 201308-0938-004
Status: Historical Active	Previous ICR Reference No: 201107-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No: 20262
Title: Cycle I, II, and III - "Grants to Support States in Health Insurance Rate Review and Pricing Transparency" Reporting
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/09/2013
	Date Received in OIRA: 08/06/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2016	36 Months From Approved	09/30/2014
Responses	1,463	0	1,075
Time Burden (Hours)	55,400	0	42,872
Cost Burden (Dollars)	0	0	0

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Abstract: Cycle I Process - The data collection is used by HHS to request that States and territories submit the following: oFour quarterly reports to the Secretary detailing the States' progression towards a more comprehensive rate review process, utilizing funds awarded in Cycle I Rate Review Grants. oRate review transaction data collected by the State. oOne final Cycle I report Reporting of information by grant awardees will assist HHS to perform oversight of federal grants. Cycle II Process - The data collection is used by HHS to request that States and territories submit the following: oFour quarterly reports to the Secretary detailing the States' progression towards a more comprehensive rate review process, utilizing funds awarded in Cycle II Rate Review Grants. oRate review transaction data collected by the State. oOne annual report. oOne final report at the end of the grant. Cycle III Process - The data collection will be used by HHS to request that States and territories submit the following: oAn application to apply for the Cycle III Rate Review Grants. Guidance requirements for the application are provided in the Funding Opportunity Announcement, beginning in Section 3, entitled "Program Requirements". oFour quarterly reports to the Secretary detailing the States' enhancements of their rate review programs or Data Centers. Data elements have been adjusted in order to enhance reporting on Data Center activities. oRate review transaction data collected by the State. oOne annual report. oOne final report at the end of the grant. This information will assist HHS in planning for and executing grants to States for rate review and Data Center activities. In addition, reporting of information by grant awardees will assist HHS in assuring that grant awardees report and share data with the Secretary as required by the statute.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1003 Name of Law: Ensuring that consumers get value for their dollars
  

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:
	78 FR 28222	05/14/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 44569	07/24/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 12

IC Title	Form No.	Form Name
(Cycle I) Final Report	CMS-10380, CMS-10380	Cycle I FOA ,   Cycle 1 - Final report template
(Cycle III) Application
(Cycle III) Quarterly Report	CMS-10380	Cycle III - Quarterly Report Template
(Cycle III) Transaction Data Collection	CMS-10380	Cycle III - Data
(Cycle III) Annual Report	CMS-10380	Cycle III - Annual Reporting Template
(Cycle III) Final Report	CMS-10380	Cycle III - Final Report Template
(Cycle II) Application	CMS-10380	Cycle II - FOA
(Cycle I) Quarterly Reports	CMS-10380	Cycle I - Quarterly Report
(Cycle I) Transaction Data Collection	CMS-10380	Cycle I FOA
(Cycle II) Quarterly Report	CMA-10380, CMS-10380	Cycle II FOA ,   Cycle II - Quarterly Report Template
(Cycle II) Transaction Data Collection	CMS-10380	Cycle II FOA
(Cycle II) Annual Report	CMS-10380	Cycle II FOA
(Cycle II ) Final Report - end of grant	CMS-10380	Cycle II FOA

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ICR Summary 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	1,463	1,075	0	-284	672	0
Annual Time Burden (Hours)	55,400	42,872	0	-15,136	27,664	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Program changes and adjustments will reduce the burden from the previously approved annual burden of 48,872 hours to the requested annual burden of 31,378 hours. These changes were made for two reasons. First, reporting burdens have changed due to the conclusion of cycles of funding and the initiation of new cycles of funding. The number of Cycle I respondents was updated to reflect that most states have concluded Cycle I. The number of Cycle II respondents was updated to correspond with the actual number of States and territories that applied and received grant awards. Cycle III was added, as a new FOA is being released. Second, burden estimates were updated to reflect changes in reporting due to the new Uniform Rate Review Template as well as changes in FOA requirements. As indicated previously, CMS plans to eliminate grant data submissions that are redundant due to the new Uniform Rate Review Template. This will reduce significantly the burden of data submissions. In addition, minor changes to the progress reports were made to increase reporting on pricing transparency through Data Centers, due to increased emphasis on Data Centers in the Cycle III FOA. Decreases in data submissions outweigh increased reporting on Data Centers. Thus, the overall reporting burden on states will decrease.

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Annual Cost to Federal Government: $254,760

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: 08/06/2013

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