Employer Notification Request to HHS of its Objection to Providing Contraceptive Services (CMS-10535)

ICR 201411-0938-002

OMB: 0938-1248

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2014-08-21
Supporting Statement A
2014-08-21
ICR Details
0938-1248 201411-0938-002
Historical Active
HHS/CMS
Employer Notification Request to HHS of its Objection to Providing Contraceptive Services (CMS-10535)
New collection (Request for a new OMB Control Number)   No
Emergency 11/05/2014
Approved without change 12/11/2014
Retrieve Notice of Action (NOA) 11/04/2014
  Inventory as of this Action Requested Previously Approved
06/30/2015 6 Months From Approved
122 0 0
110 0 0
0 0 0

The interim final regulations titled "Coverage of Certain Preventive Services Under the Affordable Care Act" continue to allow such eligible organizations to notify an issuer or third party administrator using EBSA Form 700, as set forth in the July 2013 final regulations. In addition, the interim final regulations permit an alternative process, consistent with the Wheaton order, under which an eligible organization could notify the Secretary of HHS that it will not act as the plan administrator or claims administrator with respect to, or contribute to the funding of, coverage of all or a subset of contraceptive services.
Please see attached emergency justification.

PL: Pub.L. 111 - 148 1563 Name of Law: Conforming Amendments
   US Code: 42 USC 300gg-13 Name of Law: Coverage of preventive health services
   PL: Pub.L. 111 - 148 1001 Name of Law: Amendments to the Public Health Service Act
  
PL: Pub.L. 111 - 148 1001 Name of Law: Amendments to the Public Health Service Act
PL: Pub.L. 111 - 148 1563 Name of Law: Conforming amendments

0938-AS49 Final or interim final rulemaking 79 FR 51092 08/27/2014

No

1
IC Title Form No. Form Name
Employer Notification Request to HHS of its Objection to Providing Contraceptive Services – Self-Certification

  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 122 0 122 0 0 0
Annual Time Burden (Hours) 110 0 110 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a new information collection request.

No
No
Yes
No
No
Uncollected
Jamaa Hill 301 492-4190

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/04/2014


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