Health Insurance Marketplace Consumer Experience Surveys: Enrollee Satisfaction Survey and Marketplace Survey Data Collection

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10488 Health Insurance Marketplace Consumer Experience Surveys: Enrollee Satisfaction Survey and Marketplace Survey	Form and Instruction	New	Available
CMS-10488 - ESS OMB Supporting Statement Part B_10-1-13 clean .docx	Supporting Statement B	Uploaded 2013-11-05	Repair queued
CMS10488 - ESS OMB Supporting Statement Part A_10-1-13 Final-trackchanges.docx	Supporting Statement A	Uploaded 2013-11-12	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209213	Health Insurance Marketplace Consumer Experience Surveys: Enrollee Satisfaction Survey and Marketplace Survey	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 201311-0938-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 20861
Title: Health Insurance Marketplace Consumer Experience Surveys: Enrollee Satisfaction Survey and Marketplace Survey Data Collection
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 02/06/2014
	Date Received in OIRA: 11/06/2013
Terms of Clearance: CMS withdraws this collection to correct technical issues; CMS will resubmit this collection for approval.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: Section 1311(c)(4) of the ACA requires the Department of Health and Human Services (HHS) to develop an enrollee satisfaction survey system that assesses consumer experience with qualified health plans (QHPs) offered through an Exchange. It also requires public display of enrollee satisfaction information by the Exchange to allow individuals to easily compare enrollee satisfaction levels between comparable plans. CMS is developing, testing and implementing two surveys, a survey for adult enrollees in QHPs and a survey for health insurance Marketplace consumers. CMS is requesting approval for information collection associated with these surveys.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 1311(c)(4), 1313, 1321(A) Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1311(c)(4) Name of Law: Patient Protection and 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 38986	06/28/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 65658	11/01/2013
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Health Insurance Marketplace Consumer Experience Surveys: Enrollee Satisfaction Survey and Marketplace Survey	CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488	Chinese Cover Letter ,   English/Spanish ,   Vendor Participation Form ,   Chinese Marketplace Survey ,   English Marketplace Survey ,   Spanish Marketplace Survey ,   Chinese QHP Enrollee Survey ,   English QHP Enrollee Survey ,   Spanish QHP Enrollee Survey

---

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.

---

Annual Cost to Federal Government: $3,707,278

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 11/06/2013

---