Program Integrity and Additional State Information Collections

Forms and Documents

Document Name	Status
Appendix E - Part 156 Subpart I .pdf Supplementary Document	2013-09-13
Appendix D - AV Continuance Tables.xlsm Supplementary Document	2013-09-13
Appendix C - Habilitative Services.pdf Supplementary Document	2013-09-13
Appendix B Data Elements for Notices Part 155 156 157 .pdf Supplementary Document	2013-09-13
Appendix A - Agents and Brokers.pdf Supplementary Document	2013-09-13
CMS-10490.Supporting Statement Part A.docx Supporting Statement A	2013-09-13

IC Document Collections

IC ID	Document Title	Status
208543	45 CFR 156.1230	Removed
208542	45 CFR 156.1210	Removed
208540	45 CFR 156.1230	Removed
208539	45 CFR 156.1210	Removed
208538	45 CFR 156.1010	Removed
208537	45 CFR 156.901-156.963	Removed
208536	45 CFR 156.715	Removed
208535	45 CFR 156.715	Removed
208534	156.1230(a)(2)	Modified
208533	156.1230(a)(1)	Modified
208532	156.1010	Modified
208531	156.135	Modified
208530	155.115 - Habilitative Services	Modified
208529	Notices	Modified
208528	Records Storage	Modified
208527	Notice of Appeals Actions	Modified
208526	Forms - Appeal Withdrawal, Request to Vacate a Dismissal, Special Considerations and Appointment of Authorized Representative	Modified
208525	Evidence Submission	Modified
208524	Appeals	Modified
208523	Appeals - Appeal Form	Modified
208522	155.310(k)	Modified
208521	155.260 - Agents and Brokers	Modified
208520	155.260 - Certified Application Counselors	Modified
208519	155.260 - Navigators	Modified
208518	155.220(g)(2)	Modified
208517	155.220(c)(4)	Modified
208516	155.220(c)(3)(vii)	Modified

ICR Details

OMB Control No: 0938-1213	ICR Reference No: 201309-0938-019
Status: Historical Active	Previous ICR Reference No: 201307-0938-016
Agency/Subagency: HHS/CMS	Agency Tracking No: 20541
Title: Program Integrity and Additional State Information Collections
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/21/2013
	Date Received in OIRA: 09/17/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2016	36 Months From Approved
Responses	432,468	0	0
Time Burden (Hours)	1,773,090	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The data collections and third-party disclosure requirements will assist HHS in determining Exchange compliance with Federal standards. The data collection and third-party disclosure requirements will also assist HHS in monitoring QHP issuers in FFEs for compliance with Federal QHP issuer standards. The data collected by health insurance issuers and Exchanges will help to inform HHS, Exchanges, and health insurance issuers as to the participation of individuals, employers, and employees in the individual Exchange, the SHOP, and the premium stabilization programs.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1321(a) Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1321(c)(1) Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1321(c)(2) Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1312(e) Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1311(c)(4) Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1313 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1342 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1401 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1411-1413 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1402 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 2201 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1302(a)(3) Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1302(d)(2)(A) Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1311(c)(4) Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1321(a) Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1321(c)(1) Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1321(c)(2) Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1312(e) Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1313 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1342 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1401 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1411-1413 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1402 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 2201 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1302(a)(3) Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1302(d)(2)(A Name of Law: Affordable Care Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AR82	Final or interim final rulemaking	78 FR 54069	08/30/2013

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 19

IC Title	Form No.	Form Name
Appeals
Evidence Submission
Forms - Appeal Withdrawal, Request to Vacate a Dismissal, Special Considerations and Appointment of Authorized Representative
Notice of Appeals Actions
Records Storage
Notices
155.115 - Habilitative Services
156.135
156.1010
156.1230(a)(1)
156.1230(a)(2)
45 CFR 156.715
45 CFR 156.715
45 CFR 156.901-156.963
45 CFR 156.1010
45 CFR 156.1210
45 CFR 156.1230
45 CFR 156.1210
45 CFR 156.1230
155.220(c)(3)(vii)
155.220(c)(4)
155.220(g)(2)
155.260 - Navigators
155.260 - Certified Application Counselors
155.260 - Agents and Brokers
155.310(k)
Appeals - Appeal Form

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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	432,468	0	432,468	0	0	0
Annual Time Burden (Hours)	1,773,090	0	1,773,090	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 new information collection request.

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Annual Cost to Federal Government: $0

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: 09/16/2013

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