Minimum Essential Coverage

Forms and Documents

Document Name	Status
Form CMS-10465 Minimum Essential Coverage Certification Form and Instruction	Modified
CMS-10465 Change request final.docx Justification for No Material/Nonsubstantive Change	2013-09-17
CMS-10465 MEC Supporting Statement - Part A_finalrev.doc Supporting Statement A	2013-09-17

IC Document Collections

IC ID	Document Title	Status
205752	Minimum Essential Coverage Certification Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1189	ICR Reference No: 201309-0938-029
Status: Historical Active	Previous ICR Reference No: 201308-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: 20552
Title: Minimum Essential Coverage
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/30/2013
	Date Received in OIRA: 09/27/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2016	09/30/2016	09/30/2016
Responses	10	0	10
Time Burden (Hours)	53	0	53
Cost Burden (Dollars)	2,200	0	2,200

---

Abstract: The NPRM titled "Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions; Miscellaneous Minimum Essential Coverage Provisions" proposes to designate certain types of health coverage as minimum essential coverage. Other types of coverage, not statutorily designated and not designated as minimum essential coverage in this regulation, may be recognized as minimum essential coverage if certain substantive and procedural requirements are met. The proposed rule would require coverage recognized to be minimum essential coverage to offer substantially the same consumer protections as those enumerated in the Title I of Affordable Care Act relating to non-grandfathered, individual coverage to ensure consumers are receiving adequate coverage. The proposed rule would require sponsors of individual coverage that seek to have such coverage designated as minimum essential coverage to adhere to certain procedures. Sponsoring organizations would have to submit to HHS information about their coverage and an attestation that the plan substantially complies with the provisions of Title I of the Affordable Care Act as applicable to non-grandfathered individual health insurance coverage. Sponsors would also have to a notice to enrollees informing them that the plan has been designated minimum essential coverage for the purposes of the individual coverage requirement.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 1501 Name of Law: Amendment to the Internal Revenue Code
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AR68	Final or interim final rulemaking	78 FR 39493	07/01/2013

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

---

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

IC Title	Form No.	Form Name
Minimum Essential Coverage Certification	CMS-10465, CMS-10465	Minimum Essential Coverage Certification (WORD) ,   Minimum Essential Coverage Certification (optional Excel file)

---

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	10	10	0	0	0	0
Annual Time Burden (Hours)	53	53	0	0	0	0
Annual Cost Burden (Dollars)	2,200	2,200	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:

---

Annual Cost to Federal Government: $2,160

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: 09/18/2013

---