State Health Insurance Exchange Security Incident Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10496 Incident Reporting	Form and Instruction	New	Available
Memo to Shelanski07232013.pdf	Supplementary Document	Uploaded 2013-08-27	Available
CMS-10496_Supporting_Statement_Part_A.pdf	Supporting Statement A	Uploaded 2013-08-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208397	Incident Reporting	Form and Instruction	New

ICR Details

OMB Control No: 0938-1216	ICR Reference No: 201308-0938-026
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 20421
Title: State Health Insurance Exchange Security Incident Report
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 09/15/2013
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/30/2013
	Date Received in OIRA: 08/27/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2014	6 Months From Approved
Responses	936	0	0
Time Burden (Hours)	234	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: As part of the privacy and security oversight of State Health Insurance Exchanges the States will be required to report security incidents include breaches of personally identifiable information (PII). This reporting will be made by completing and electronically submitting the State Health Insurance Exchange Security Incident Report (Incident Report), or providing identical information telephonically.

Emergency Justfication: The Centers for Medicare & Medicaid Services (CMS) is requesting that an information collection request for State Health Insurance Exchange Security Incident Reporting to be processed under the emergency clearance process associated with Paperwork Reduction Act of 1995 (PRA), specifically 5 CFR 1320.13(a)(2)(i). Public harm is reasonably likely to occur ifthe normal, non-emergency -clearance procedures are fo llowed. The approval of this data collection process is essential to ensuring that Information Security (IS) incidents, which also include Personally Identifiable Information (PII) and Protected Health Information (PHI), are captured within the specified timeframe. In absence of this change, a significant number of incidents will not be detected; therefore causing harm and potential risk to the public's identity with identity fraud . Additionally, in accordance with 5 CFR 1320 13 (a)(2)(iii), a statutory implementation date of the Affordable Care Act, which is October 1, 2013 , will be missed, ifthe normal clearance procedures are followed. Incidents could potentially occur on this statutory date; therefore, the reporting capability must be in place for States to inform CMS should an incident occur during this time.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 Title1 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 Title 1 Name of Law: Affordable Care Act

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 51729	08/21/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 51729	08/21/2013
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Incident Reporting	CMS-10496	STATE HEALTH INSURANCE EXCHANGE SECURITY INCIDENT REPORT

---

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	936	0	936	0	0	0
Annual Time Burden (Hours)	234	0	234	0	0	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: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

---

Annual Cost to Federal Government: $502

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

---

Common Form ICR:  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:

(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: 08/27/2013

---