Reporting Requirements for Grants to States for Rate Review Cycle IV and Effective Rate Review Program (CMS-10380)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10380 Grant Program Data Dictionary	Form	New	Available
Form CMS-10380 Rate Review Grant cycle IV - Annual Report	Form and Instruction	New	Available
Form CMS-10380 Rate Review Program Quarterly Report	Form and Instruction	New	Available
Form CMS-10380 Cycle III - Final Report Template	Form and Instruction	Removed	Available
Form CMS-10380 Cycle III - Annual Reporting Template	Form and Instruction	Removed	Available
Form CMS-10380 Cycle III - Data	Form and Instruction	Removed	Available
Form CMS-10380 Cycle III - Quarterly Report Template	Form and Instruction	Removed	Available
Form CMS-10380 Cycle 1 - Final report template	Form and Instruction	Removed	Available
Form CMS-10380 Cycle I FOA	Form and Instruction	Removed	Available
Form CMS-10380 Cycle II FOA	Form and Instruction	Removed	Available
Form CMS-10380 Cycle II FOA	Form and Instruction	Removed	Available
Form CMS-10380 Cycle II FOA	Form and Instruction	Removed	Available
Form CMS-10380 Cycle II - Quarterly Report Template	Form and Instruction	Removed	Available
Form CMA-10380 Cycle II FOA	Form and Instruction	Removed	Available
Form CMS-10380 Cycle I FOA	Form and Instruction	Removed	Available
Form CMS-10380 Cycle I - Quarterly Report	Form and Instruction	Removed	Available
Rate Review Grants_CMS-10380 SupportingStatement_Part-A_08-28JH-14 Clean.docx	Supporting Statement A	Uploaded 2014-08-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
212866	Rate Review Program Grant - Cycle IV Application		New
212865	Effective Rate Review Program		New
212864	Transaction Data Collection	Form	New	Grant Program Data Dictionary
212863	Rate Review Program Grant - Cycle IV Final Report		New
212861	Rate Review Grant - Cycle IV Annual Report	Form and Instruction	New	Rate Review Grant cycle IV - Annual Report
212860	Rate Review Program Grant - Cycle IV Quarterly Report	Form and Instruction	New	Rate Review Program Quarterly Report
208094	(Cycle III) Final Report	Form and Instruction	Removed	Cycle III - Final Report Template
208093	(Cycle III) Annual Report	Form and Instruction	Removed	Cycle III - Annual Reporting Template
208092	(Cycle III) Transaction Data Collection	Form and Instruction	Removed	Cycle III - Data
208091	(Cycle III) Quarterly Report	Form and Instruction	Removed	Cycle III - Quarterly Report Template
208090	(Cycle III) Application	Other-Data	Removed
198639	(Cycle I) Final Report	Form and Instruction	Removed	Cycle 1 - Final report template
198639	(Cycle I) Final Report	Form and Instruction	Removed	Cycle I FOA
196347	(Cycle II ) Final Report - end of grant	Form and Instruction	Removed	Cycle II FOA
196346	(Cycle II) Annual Report	Form and Instruction	Removed	Cycle II FOA
196345	(Cycle II) Transaction Data Collection	Form and Instruction	Removed	Cycle II FOA
196344	(Cycle II) Quarterly Report	Form and Instruction	Removed	Cycle II - Quarterly Report Template
196344	(Cycle II) Quarterly Report	Form and Instruction	Removed	Cycle II FOA
196341	(Cycle I) Transaction Data Collection	Form and Instruction	Removed	Cycle I FOA
196340	(Cycle I) Quarterly Reports	Form and Instruction	Removed	Cycle I - Quarterly Report

ICR Details

OMB Control No: 0938-1121	ICR Reference No: 201408-0938-009
Status: Historical Active	Previous ICR Reference No: 201308-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: 20262
Title: Reporting Requirements for Grants to States for Rate Review Cycle IV and Effective Rate Review Program (CMS-10380)
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: 10/17/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/28/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	36 Months From Approved	09/30/2016
Responses	553	0	1,463
Time Burden (Hours)	20,951	0	55,400
Cost Burden (Dollars)	0	0	0

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Abstract: On May 23, 2011, CMS published a final rule with comment period (76 FR 29964) to implement the annual review of unreasonable increases in premiums for health insurance coverage called for by section 2794. Under the regulation, if CMS determines that a state has an effective rate review program in a given market, using the criteria set forth in the rule, CMS will adopt that state's determinations regarding whether rate increases in that market are unreasonable, provided that the state reports its final determinations to CMS and explains the bases of its determinations. The final rule titled "Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review" (78 FR 13406, February 27, 2013) amends the standards under the rate review program. Currently, CMS relies on publicly available information and annual calls with individual States to obtain the information needed to determine whether a State has an effective rate review program. CMS is proposing to instead collect the information in writing from all States that would like to request effective status.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1003 Name of Law: Ensuring that consumers get value for their dollars
  

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:
	79 FR 31336	06/02/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 50655	08/25/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
(Cycle I) Final Report	CMS-10380, CMS-10380	Cycle I FOA ,   Cycle 1 - Final report template
(Cycle I) Quarterly Reports	CMS-10380	Cycle I - Quarterly Report
(Cycle I) Transaction Data Collection	CMS-10380	Cycle I FOA
(Cycle II ) Final Report - end of grant	CMS-10380	Cycle II FOA
(Cycle II) Annual Report	CMS-10380	Cycle II FOA
(Cycle II) Quarterly Report	CMA-10380, CMS-10380	Cycle II FOA ,   Cycle II - Quarterly Report Template
(Cycle II) Transaction Data Collection	CMS-10380	Cycle II FOA
(Cycle III) Annual Report	CMS-10380	Cycle III - Annual Reporting Template
(Cycle III) Application
(Cycle III) Final Report	CMS-10380	Cycle III - Final Report Template
(Cycle III) Quarterly Report	CMS-10380	Cycle III - Quarterly Report Template
(Cycle III) Transaction Data Collection	CMS-10380	Cycle III - Data
Effective Rate Review Program
Rate Review Grant - Cycle IV Annual Report	CMS-10380	Rate Review Grant cycle IV - Annual Report
Rate Review Program Grant - Cycle IV Application
Rate Review Program Grant - Cycle IV Final Report
Rate Review Program Grant - Cycle IV Quarterly Report	CMS-10380	Rate Review Program Quarterly Report
Transaction Data Collection	CMS-10380	Grant Program Data Dictionary

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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	553	1,463	0	-910	0	0
Annual Time Burden (Hours)	20,951	55,400	0	-34,449	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: All instruments and burden estimates associated with Cycle I, II, and III have been deleted as the data collection requirements do not apply to the Cycle IV grant program. As a result of this revision the number of responses decreased by 1,239. The number of hours decreased by 49,240. Changes to the application process for Cycle IV will reduce the burden from that in Cycle III by one hour (from 160 to 159) per application. The burden for preparing and submitting the application was updated to reflect that applicants are no longer required to obtain a letter from the Governor or independently-elected Insurance Commissioner as part of the application process. This requirement was eliminated in the Cycle IV application process. There will be additional burden related to Cycle IV. We estimate that the one-time burden related to grant applications will be 6,678 hours or $6,154 and the annual burden related to reporting is estimated to be 14,028 hours or $724,094. The additional burden related to the Effective Rate Review Program is estimated to be 245 hours or $15,658.81 annually.

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Annual Cost to Federal Government: $238,538

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: 08/28/2014

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