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 Chinese - Marketplace Survey	Form and Instruction	Unchanged	Available
Form CMS-10488 Spanish - Marketplace Survey	Form and Instruction	Unchanged	Repair queued
Form CMS-10488 English - Marketplace Survey	Form and Instruction	Unchanged	Available
Form CMS-10488 Chinese - Qualified Health Plan Enrollee Experience	Form and Instruction	Modified	Repair queued
Form CMS-10488 Spanish - Qualified Health Plan Enrollee Experience Survey	Form and Instruction	Modified	Available
Form CMS-10488 English Adult QHP Enrollee Survey	Form and Instruction	Modified	Available
Form CMS-10488 Vendor Form	Form and Instruction	Modified	Available
CMS-10488 - ESS OMB Supporting Statement Part A_Clean.docx	Supporting Statement A	Uploaded 2014-07-31	Available
CMS-10488 - ESS OMB Supporting Statement Part B_Clean.docx	Supporting Statement B	Uploaded 2014-07-31	Available
CMS-10488 - Change Request-07292014.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-07-31	Available
CMS-10488 - Change Request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-02-19	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210331	Marketplace Survey Data Collection	Form and Instruction	Unchanged	Chinese - Marketplace Survey
210331	Marketplace Survey Data Collection	Form and Instruction	Unchanged	Spanish - Marketplace Survey
210331	Marketplace Survey Data Collection	Form and Instruction	Unchanged	English - Marketplace Survey
210330	Adult Qualified Health Plan Enrollee Experience Survey	Form and Instruction	Modified	Chinese - Qualified Health Plan Enrollee Experience
210330	Adult Qualified Health Plan Enrollee Experience Survey	Form and Instruction	Modified	Spanish - Qualified Health Plan Enrollee Experience Survey
210330	Adult Qualified Health Plan Enrollee Experience Survey	Form and Instruction	Modified	English Adult QHP Enrollee Survey
210330	Adult Qualified Health Plan Enrollee Experience Survey	Form and Instruction	Modified	Vendor Form

ICR Details

OMB Control No: 0938-1221	ICR Reference No: 201407-0938-016
Status: Historical Active	Previous ICR Reference No: 201402-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No: 21457
Title: Health Insurance Marketplace Consumer Experience Surveys: Enrollee Satisfaction Survey and Marketplace Survey Data Collection
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/05/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/31/2014
Terms of Clearance: Prior terms remain in effect: The psychometric test component of this information collection is not designed to provide state-level or QHP-level estimates; as such only the aggregate results of this analysis will be discussed or disseminated. The second component of this information collection (in 2015) includes a provision for early feedback to States and QHPs, subject to the limitations associated with response rates (including non-response bias analyses) and data quality findings. Approval has not yet been provided for the early feedback/beta test component described in the supporting statements; rather CMS will submit a change package to OMB for that clearance once the results of the psychometric test component have been analyzed. CMS should confer with OMB to determine whether the changes made as a result of the psychometric test component constitute a substantive change.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2017	02/28/2017	02/28/2017
Responses	668,590	0	668,590
Time Burden (Hours)	297,670	0	297,670
Cost Burden (Dollars)	0	0	0

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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.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1313 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1321(a) Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1311(c)(4) Name of Law: Affordable Care Act (ACA)
  

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

Did the Agency receive public comments on this ICR? Yes

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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
Adult Qualified Health Plan Enrollee Experience Survey	CMS-10488, CMS-10488, CMS-10488, CMS-10488	Vendor Form ,   English Adult QHP Enrollee Survey ,   Spanish - Qualified Health Plan Enrollee Experience Survey ,   Chinese - Qualified Health Plan Enrollee Experience
Marketplace Survey Data Collection	CMS-10488, CMS-10488, CMS-10488	English - Marketplace Survey ,   Spanish - Marketplace Survey ,   Chinese - Marketplace Survey

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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	668,590	668,590	0	0	0	0
Annual Time Burden (Hours)	297,670	297,670	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

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

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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: 07/31/2014

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