State Children's Health Insurance Program and Supporting Regulations in 42 CFR 431.636, 457.50, 457.60, 457.70, 457.340, 457.350, 457.431, 457.440, 457.525, 457.560,...

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-R-308 - Response to Public Comment [rev 1-22-2014 by OSORA PRA].docx	Supplementary Document	Uploaded 2014-01-23	Repair queued
CMS-R-308 - Supporting Statement part A [rev 1-23-2014 #2 by OSORA PRA].doc	Supporting Statement A	Uploaded 2014-01-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8644	State Children's Health Insurance Program and Supporting Regulations in 42 CFR 431.636, 457.50, 457.60, 457.70, 457.340, 457.350, 457.431, 457.440, 457.525, 457.560,...		Modified

ICR Details

OMB Control No: 0938-0841	ICR Reference No: 201401-0938-014
Status: Historical Active	Previous ICR Reference No: 201010-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: 21337
Title: State Children's Health Insurance Program and Supporting Regulations in 42 CFR 431.636, 457.50, 457.60, 457.70, 457.340, 457.350, 457.431, 457.440, 457.525, 457.560,...
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/12/2014
	Date Received in OIRA: 01/29/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved	03/31/2014
Responses	28,294,596	0	1,114,124
Time Burden (Hours)	1,473,855	0	864,973
Cost Burden (Dollars)	0	0	0

---

Abstract: States are required to submit title XXI plans and amendments for approval by the Secretary pursuant to section 2102 of the Social Security Act in order to receive funds for initiating and expanding health insurance coverage for uninsured children. States are also required to submit State expenditure and statistical reports, annual reports and State evaluations to the Secretary as outlined in the XXI of the Social Security Act.

---

Authorizing Statute(s): Statute at Large: 21 Stat. 2101 Name of Statute: null
   Statute at Large: 21 Stat. 2102 Name of Statute: null
   Statute at Large: 21 Stat. 2106 Name of Statute: null
   Statute at Large: 21 Stat. 2107 Name of Statute: null
  

Citations for New Statutory Requirements: None

---

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 61848	10/04/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 3818	01/23/2014
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
State Children's Health Insurance Program and Supporting Regulations in 42 CFR 431.636, 457.50, 457.60, 457.70, 457.340, 457.350, 457.431, 457.440, 457.525, 457.560,...

---

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	28,294,596	1,114,124	0	0	27,180,472	0
Annual Time Burden (Hours)	1,473,855	864,973	0	0	608,882	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: While there were no program changes, there are a number of adjustments to our burden estimates that were made based on using more current data and correcting miscalculations. More specifically: Section 457.340: Revised the number of states with a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). Section 457.350: Revised the number of states with a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). Noted that the previous calculation is incorrect - $23.63 per hour X 218,300 hours = $5,158,429. Section 457.525: The 2011 calculation was incorrect. If following the formula, then the hourly rate is multiplied by the total number of hours: $23.63 x 118,040 = $2,7879,285. Section 457.570: Revised the number of states with a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). Section 457.940: Revised the number of states with a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). Section 457.945: Revised the number of states with a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). Section 457.985: Revised the number of states with a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). Section 457.1180: Revised the number of CHIP enrollees in a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). In addition to the adjustments noted above, this package also corrects the number of responses and the total hour burden that was set out in the 2011 PRA package (approved January 10, 2011). In that regard, this package adds a burden table under section 12 of this Supporting Statement to help clarify the 2014 burden estimates and calculations.

---

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]? No

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: 01/29/2014

---