Health Care Reform Insurance Web Portal (CMS-10320)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10320 Appendix D - Data Collection 2014	Form and Instruction	Modified	Available
Form CMS-10320 Appendix C - Insurance Issuer and Product Level Data	Form and Instruction	Modified	Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments	Form and Instruction	Modified	Repair queued
Form CMS-10320 Appendix D - Data Collection 2014	Form and Instruction	Modified	Available
Form CMS-10320 Appendix C - Insurance Issuer and Product Level Data	Form and Instruction	Modified	Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments	Form and Instruction	Modified	Available
Form CMS-10320 Appendix S - Data Collection 2014	Form and Instruction	Modified	Available
Form CMS-10320 Appendix C - Insurance Issuer and Product Level Data	Form and Instruction	Modified	Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments	Form and Instruction	Modified	Available
Form CMS-10320 Appendix D - Data Collection 2014	Form and Instruction	Modified	Available
Form CMS-10320 Appendix C - Insurance Issuer and Product Level Data	Form and Instruction	Modified	Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments	Form and Instruction	Modified	Available
Form CMS-10320 Appendix D - Data Collection 2014	Form and Instruction	Modified	Available
Form CMS-10320 Appendix C - Insurance Issuer and Product Level Data	Form and Instruction	Modified	Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments	Form and Instruction	Modified	Available
Form CMS-10320 Appendix D - Data Collection 2014	Form and Instruction	Modified	Available
Form CMS-10320 Appendix C - Issurance Issuer and Product Level Data	Form and Instruction	Modified	Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments	Form and Instruction	Modified	Available
Form CMS-10320 Data Collection 2014	Form and Instruction	Modified	Available
Form CMS-10320 Appendic C - Insurance Issuer and Product Level Data	Form and Instruction	Modified	Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments	Form and Instruction	Modified	Available
Form CMS-10320 Appendix D - Data Collection 2014	Form and Instruction	Modified	Available
Form CMS-10320 Appendix C - Insurance Issurer and Product Level Data	Form and Instruction	Modified	Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments	Form and Instruction	Modified	Available
Form CMS-10320 Appendix D	Form and Instruction	Modified	Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments	Form and Instruction	Modified	Available
Form CMS-10320 Appendix C Insurance Issuer and Product Level Data	Form and Instruction	Modified	Available
Form CMS-10320 State Instructions and Application	Form and Instruction	Modified	Repair queued
Form CMS-10320 Appendix E - State Requirements	Form and Instruction	Modified	Available
Form CMS-10320 Appendix E - State Requirements	Form and Instruction	Modified	Available
Form CMS-10320 CMS-10320.FINAL State Instructions and Instrument (5-5-10).	Form and Instruction	Modified	Available
Form CMS-10320 Appendix E - State Requirements	Form and Instruction	Modified	Available
Form CMS-10320 CMS-10320.FINAL State Instructions and Instrument (5-5-10).	Form and Instruction	Modified	Available
CMS-10320 - Major Changes as requested by OMB Final.docx	Supplementary Document	Uploaded 2014-06-18	Available
CMS-10320 Summary of Changes.docx	Supplementary Document	Uploaded 2014-06-04	Available
CMS-10320 - Appendix_F_PoolRequirements_v2.pdf	Supplementary Document	Uploaded 2014-04-11	Available
CMS-10320 - Appendix_B_Section1103.pdf	Supplementary Document	Uploaded 2014-04-11	Available
CMS-10320 - Supporting Statement 30day App A 2014docx.pdf	Supporting Statement A	Uploaded 2014-04-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
199284	Issuer - Attest (Small Group)	Form and Instruction	Modified	Appendix D - Data Collection 2014
199284	Issuer - Attest (Small Group)	Form and Instruction	Modified	Appendix C - Insurance Issuer and Product Level Data
199284	Issuer - Attest (Small Group)	Form and Instruction	Modified	CMS-10320.Issuer - FINAL Instructions and Instruments
199283	Issuer - Attest (Individual)	Form and Instruction	Modified	Appendix D - Data Collection 2014
199283	Issuer - Attest (Individual)	Form and Instruction	Modified	Appendix C - Insurance Issuer and Product Level Data
199283	Issuer - Attest (Individual)	Form and Instruction	Modified	CMS-10320.Issuer - FINAL Instructions and Instruments
199282	Issuer - Troubleshoot (Small Group)	Form and Instruction	Modified	Appendix S - Data Collection 2014
199282	Issuer - Troubleshoot (Small Group)	Form and Instruction	Modified	Appendix C - Insurance Issuer and Product Level Data
199282	Issuer - Troubleshoot (Small Group)	Form and Instruction	Modified	CMS-10320.Issuer - FINAL Instructions and Instruments
199281	Issuer - Troubleshoot (Individual)	Form and Instruction	Modified	Appendix D - Data Collection 2014
199281	Issuer - Troubleshoot (Individual)	Form and Instruction	Modified	Appendix C - Insurance Issuer and Product Level Data
199281	Issuer - Troubleshoot (Individual)	Form and Instruction	Modified	CMS-10320.Issuer - FINAL Instructions and Instruments
199280	Issuer - Data Entry (Small Group)	Form and Instruction	Modified	Appendix D - Data Collection 2014
199280	Issuer - Data Entry (Small Group)	Form and Instruction	Modified	Appendix C - Insurance Issuer and Product Level Data
199280	Issuer - Data Entry (Small Group)	Form and Instruction	Modified	CMS-10320.Issuer - FINAL Instructions and Instruments
199279	Issuer - Data Entry (Individual)	Form and Instruction	Modified	Appendix D - Data Collection 2014
199279	Issuer - Data Entry (Individual)	Form and Instruction	Modified	Appendix C - Issurance Issuer and Product Level Data
199279	Issuer - Data Entry (Individual)	Form and Instruction	Modified	CMS-10320.Issuer - FINAL Instructions and Instruments
199278	Issuers - Submission Preparation (Small Group)	Form and Instruction	Modified	Data Collection 2014
199278	Issuers - Submission Preparation (Small Group)	Form and Instruction	Modified	Appendic C - Insurance Issuer and Product Level Data
199278	Issuers - Submission Preparation (Small Group)	Form and Instruction	Modified	CMS-10320.Issuer - FINAL Instructions and Instruments
199277	Issuers - Submission Preparation (Individual)	Form and Instruction	Modified	Appendix D - Data Collection 2014
199277	Issuers - Submission Preparation (Individual)	Form and Instruction	Modified	Appendix C - Insurance Issurer and Product Level Data
199277	Issuers - Submission Preparation (Individual)	Form and Instruction	Modified	CMS-10320.Issuer - FINAL Instructions and Instruments
199276	Issuers Training and Communication	Form and Instruction	Modified	Appendix D
199276	Issuers Training and Communication	Form and Instruction	Modified	CMS-10320.Issuer - FINAL Instructions and Instruments
199276	Issuers Training and Communication	Form and Instruction	Modified	Appendix C Insurance Issuer and Product Level Data
199275	States - Data Collection	Form and Instruction	Modified	State Instructions and Application
199275	States - Data Collection	Form and Instruction	Modified	Appendix E - State Requirements
192726	States - Training, reviewing regulation, and analyzing data	Form and Instruction	Modified	Appendix E - State Requirements
192726	States - Training, reviewing regulation, and analyzing data	Form and Instruction	Modified	CMS-10320.FINAL State Instructions and Instrument (5-5-10).
192725	States - Data submission	Form and Instruction	Modified	Appendix E - State Requirements
192725	States - Data submission	Form and Instruction	Modified	CMS-10320.FINAL State Instructions and Instrument (5-5-10).

ICR Details

OMB Control No: 0938-1086	ICR Reference No: 201404-0938-002
Status: Historical Active	Previous ICR Reference No: 201212-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-10320
Title: Health Care Reform Insurance Web Portal (CMS-10320)
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: 07/03/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/11/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved	03/31/2016
Responses	5,500	0	5,550
Time Burden (Hours)	89,725	0	91,225
Cost Burden (Dollars)	0	0	0

---

Abstract: HHS has developed and implemented an Internet website portal to assist consumers with identifying affordable and comprehensive health insurance coverage options that are available in their State. The Department has created a system where insurance issuers and their states log into the web portal using a custom user ID and password validation. The states were asked to provide information on issuers in their state and various websites (see Appendix E). The issuers have been downloading a basic information template to enter data then upload into the portal. Information to be collected on issuers and products can be found in Appendix C. The pricing and benefits data that will be collected can be found in Appendix D. The templates and instructions presented in support of this PRA package as Appendix G are those developed for the prior data collections.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 1103 Name of Law: The Patient Protection and Affordability Care Act
   PL: Pub.L. 111 - 148 10102 Name of Law: The Patient Protection and Affordability Care Act
  

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:
	79 FR 6197	02/03/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 20209	04/11/2014
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 12

table that charts list of burden

IC Title	Form No.	Form Name
Issuer - Attest (Individual)	CMS-10320, CMS-10320, CMS-10320	CMS-10320.Issuer - FINAL Instructions and Instruments ,   Appendix C - Insurance Issuer and Product Level Data ,   Appendix D - Data Collection 2014
Issuer - Attest (Small Group)	CMS-10320, CMS-10320, CMS-10320	CMS-10320.Issuer - FINAL Instructions and Instruments ,   Appendix C - Insurance Issuer and Product Level Data ,   Appendix D - Data Collection 2014
Issuer - Data Entry (Individual)	CMS-10320, CMS-10320, CMS-10320	CMS-10320.Issuer - FINAL Instructions and Instruments ,   Appendix C - Issurance Issuer and Product Level Data ,   Appendix D - Data Collection 2014
Issuer - Data Entry (Small Group)	CMS-10320, CMS-10320, CMS-10320	CMS-10320.Issuer - FINAL Instructions and Instruments ,   Appendix C - Insurance Issuer and Product Level Data ,   Appendix D - Data Collection 2014
Issuer - Troubleshoot (Individual)	CMS-10320, CMS-10320, CMS-10320	CMS-10320.Issuer - FINAL Instructions and Instruments ,   Appendix C - Insurance Issuer and Product Level Data ,   Appendix D - Data Collection 2014
Issuer - Troubleshoot (Small Group)	CMS-10320, CMS-10320, CMS-10320	CMS-10320.Issuer - FINAL Instructions and Instruments ,   Appendix C - Insurance Issuer and Product Level Data ,   Appendix S - Data Collection 2014
Issuers - Submission Preparation (Individual)	CMS-10320 , CMS-10320, CMS-10320	CMS-10320.Issuer - FINAL Instructions and Instruments ,   Appendix C - Insurance Issurer and Product Level Data ,   Appendix D - Data Collection 2014
Issuers - Submission Preparation (Small Group)	CMS-10320, CMS-10320, CMS-10320	CMS-10320.Issuer - FINAL Instructions and Instruments ,   Appendic C - Insurance Issuer and Product Level Data ,   Data Collection 2014
Issuers Training and Communication	CMS-10320, CMS-10320, CMS-10320	CMS-10320.Issuer - FINAL Instructions and Instruments ,   Appendix C Insurance Issuer and Product Level Data ,   Appendix D
States - Data submission	CMS-10320, CMS-10320	CMS-10320.FINAL State Instructions and Instrument (5-5-10). ,   Appendix E - State Requirements
States - Data Collection	CMS-10320, CMS-10320	Appendix E - State Requirements ,   State Instructions and Application
States - Training, reviewing regulation, and analyzing data	CMS-10320, CMS-10320	CMS-10320.FINAL State Instructions and Instrument (5-5-10). ,   Appendix E - State Requirements

---

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	5,500	5,550	0	0	-50	0
Annual Time Burden (Hours)	89,725	91,225	0	0	-1,500	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: There is an overall reduction of 1,500 hours (from 91,225 hours to 89,725 hours) due to a decrease in the number of issuers reporting from 800 to 750.

---

Annual Cost to Federal Government: $15,161,494

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: 04/11/2014

---