Coverage of Certain Preventive Services Under the Affordable Care Act

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10459 Notice	Form and Instruction	New	Repair queued
Form CMS-10459 Certification	Form and Instruction	New	Available
CMS-10459 Summary of Changes.docx	Supplementary Document	Uploaded 2013-11-19	Available
CMS-10459 Supporting Statement - Part A.pdf	Supporting Statement A	Uploaded 2013-11-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209380	Notice	Form and Instruction	New
209379	Certification	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 201311-0938-024
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 20980
Title: Coverage of Certain Preventive Services Under the Affordable Care Act
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 08/21/2014
	Date Received in OIRA: 11/19/2013
Terms of Clearance: CMS withdraws this collection to consolidate it with another submission.

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

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Abstract: Section 2713 of the Public Health Service Act requires coverage without cost sharing of certain preventive health services, including certain contraceptive services, in non-exempt, non-grandfathered group health plans and health insurance coverage. The final regulations "Coverage of Certain Preventive Services Under the Affordable Care Act" published by the Departments of Health and Human Services, the Treasury, and Labor, amend the authorization to exempt group health plans established or maintained by certain religious employers (and group health insurance coverage provided in connection with such plans) with respect to the requirement to cover contraceptive services. The final regulations also establish accommodations for group health plans established or maintained by certain additional religious organizations (and group health insurance coverage offered in connection with such plans), and for student health insurance coverage arranged by certain religious institutions of higher education. Each organization seeking accommodation under the proposed rules must self-certify that it meets the definition of eligible organization and provide a copy to a group health insurance coverage issuer. The proposed rules direct a health insurance issuer providing separate payments for contraceptive services at no additional cost to participants and beneficiaries in plans of eligible organizations to provide a written notice to plan participants and beneficiaries regarding the availability of the separate payment for contraceptive services.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1001 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1563 Name of Law: Affordable Care Act
   US Code: 42 USC 300gg-13 Name of Law: Coverage of preventive health services
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1001 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1563 Name of Law: Affordable Care Act
US Code: 42 USC 300gg-13 Name of Law: Coverage of preventive health services

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AR42	Final or interim final rulemaking	78 FR 39870	07/02/2013

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Certification	CMS-10459	Certification
Notice	CMS-10459	Notice

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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.

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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: 11/19/2013

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