Information Collection Requirements Referenced in HIPAA for the Group Market, Supporting Regulations 45 CFR 146, and forms/instructions

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10430 Information Collection Requirements for Compliance with Individual and Group Market Reforms under Title XXVII of the Public Health Service Act	Form and Instruction	Unchanged	Available
2014_CCIIO_PlanFinder_2014_Templates_and_Dates.doc	Supplementary Document	Uploaded 2014-08-28	Available
CMS-10430 Change request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-08-28	Available
CMS-10430_Model_Notice_to_Enrollees.pdf	Supplementary Document	Uploaded 2014-08-28	Available
CMS-10430_Model_Election_Exemption.pdf	Supplementary Document	Uploaded 2014-08-28	Available
CMS-10430 Supporting Statement_clean.doc	Supporting Statement A	Uploaded 2014-08-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43664	Information Collection Requirements for Compliance with Individual and Group Market Reforms under Title XXVII of the Public Health Service Act	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0938-0702	ICR Reference No: 201408-0938-011
Status: Historical Active	Previous ICR Reference No: 201303-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No: 18923
Title: Information Collection Requirements Referenced in HIPAA for the Group Market, Supporting Regulations 45 CFR 146, and forms/instructions
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: 09/28/2014
	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	04/30/2016	04/30/2016	04/30/2016
Responses	39,831,442	0	39,831,442
Time Burden (Hours)	3,760,421	0	3,760,421
Cost Burden (Dollars)	0	0	0

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Abstract: The provisions of title XXVII of the Public Health Service Act (PHS Act) are designed to make it easier for people to get access to health care coverage and to reduce the limitations that can be put on the coverage. Sections 2723 and 2761 of the PHS Act direct CMS to enforce a provision (or provisions) of title XXVII of the PHS Act with respect to health insurance issuers when a state has notified CMS that it has not enacted legislation to enforce or that it is not otherwise enforcing a provision (or provisions) of the individual and group market reforms with respect to health insurance issuers, or when CMS has determined that a state is not substantially enforcing one or more of those provisions. This collection also pertains to notices issued by individual and group health insurance issuers and self-funded non-Federal governmental plans. This collection includes the issuance of certificates of creditable coverage; notification of preexisting condition exclusions; notification of special enrollment rights; and review of issuers' filings of individual and group market products or similar Federal review in cases in which a state is not enforcing a title XXVII individual or group market provision.

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Authorizing Statute(s): US Code: 42 USC 300gg-23 Name of Law: Individual and Group Market Reforms
   US Code: 42 USC 241 Name of Law: Research and investigations generally
   PL: Pub.L. 104 - 204 title VI Name of Law: Newborns' and Mothers' Health Protection Act of 1996
   PL: Pub.L. 104 - 191 title I Name of Law: Health Insurance Portability and Accountability Act of 1996 (HIPAA)
   PL: Pub.L. 105 - 277 title IX Name of Law: The Women's Health and Cancer Rights Act of 1998
   PL: Pub.L. 111 - 148 title I Name of Law: Affordable Care Act
   PL: Pub.L. 110 - 343 title V Name of Law: Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008
   PL: Pub.L. 110 - 223 title I Name of Law: Genetic Information Nondiscrimination Act of 2008
   US Code: 42 USC 300gg-61 Name of Law: Individual Market Rules
  

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:
	77 FR 69846	11/21/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 12322	02/22/2013
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
Information Collection Requirements for Compliance with Individual and Group Market Reforms under Title XXVII of the Public Health Service Act	CMS-10430, CMS-10430	Model_Notice_to_Enrollees ,   Model_Election_Exemption

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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	39,831,442	39,831,442	0	0	0	0
Annual Time Burden (Hours)	3,760,421	3,760,421	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: The revised burden is a result of new statutory requirements under title XXVII of the PHS Act.

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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: 08/28/2014

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