Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10416 Exchange Blueprint	Form and Instruction	Modified	Available
CMS-10416 - 2015 Blueprint Key Changes_042214.docx	Supplementary Document	Uploaded 2014-05-23	Available
Marketplace Blueprint Comment Tracking Tool__External Comments_508C.pdf	Supplementary Document	Uploaded 2014-03-11	Available
Crosswalk of Changes to Marketplace Blueprint_02252014_508C.pdf	Supplementary Document	Uploaded 2014-03-11	Available
CMS-10416 - Supporting Statement_508C.pdf	Supporting Statement A	Uploaded 2014-03-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202391	Exchange Blueprint	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1172	ICR Reference No: 201403-0938-004
Status: Historical Active	Previous ICR Reference No: 201211-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No: 21561
Title: Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/17/2014
	Date Received in OIRA: 03/11/2014
Terms of Clearance: The Blueprint covered by this request applies to plan year 2016 and beyond.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	36 Months From Approved	08/31/2015
Responses	31	0	56
Time Burden (Hours)	5,552	0	11,816
Cost Burden (Dollars)	0	0	0

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Abstract: CMS is working with States (including the District of Columbia and the territories) to establish Exchanges in every State. The law gives States the opportunity to establish State-based Exchanges, subject to approval that the State-based Exchange meets federal standards and will be ready to offer health care coverage on January 1, 2014. The deadline for Exchange approval is January 1, 2013. In a State that does not achieve Exchange approval by the deadline, the law directs the Secretary of Health and Human Services to facilitate the establishment of an Exchange in that State. States will apply for approval or conditional approval of their State Exchange in the Fall of 2012 with decisions made on January 1, 2013.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1311(b) Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 50060	08/16/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 13059	03/07/2014
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Exchange Blueprint	CMS-10416	Blueprint for Approval of Affordable Healthcare Marketplaces

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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	31	56	0	-25	0	0
Annual Time Burden (Hours)	5,552	11,816	0	-6,264	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Based on the changing nature of the states' approaches to meeting the requirements of the ACA and changes in delivery format, there has been a significant reduction to the overall burden. It has been reduced by 6,264 hours. CMS has translated the application from its original paper-based format to an on-line tool that allows the states to enter the information efficiently and without redundancy. CMS has also converted many of the information requirements on the application from full explanations, requiring significant levels of effort to produce to a more streamlined "attestations" and uploading of supporting documents developed for other purposes. CMS has also revised and clarified the descriptions of various Marketplace activities to provide more concise guidance to the states. The number of responses reflects the 31 states that did not submit an application but are still eligible to submit a new Blueprint application should they wish to pursue approval from HHS/CMS for operating an SBM or State-based SHOP for coverage years beginning after January 1, 2015 and thereafter.

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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: 03/11/2014

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