Good Cause Processes (CMS-10544)

Forms and Documents

Document Name	Status
CMS-10544 - Supporting Statement A [rev 02-27-2015 by OSORA PRA].doc Supporting Statement A	2015-02-27

IC Document Collections

IC ID	Document Title	Status
215417	Good Cause Processes (Sec. 417.460, 422.74, and 423.44)	New

ICR Details

OMB Control No: 0938-1271	ICR Reference No: 201502-0938-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Good Cause Processes (CMS-10544)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/10/2015
	Date Received in OIRA: 03/03/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	36 Months From Approved
Responses	8,376	0	0
Time Burden (Hours)	4,188	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Beneficiaries are provided a protection outlined in regulation at 42 CFR 417.460, 422.74, and 423.44 that provides CMS with the ability to reinstate an individual's enrollment into a Medicare Advantage, Part D or cost plan in certain circumstances where the individual's non-payment of plan premiums was due to circumstances that the individual could not reasonably foresee or could not control, such as an unexpected hospitalization. This submission calculates the administrative cost by Medicare Advantage, Part D and cost plans to process such requests on behalf of CMS.

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Authorizing Statute(s): US Code: 18 USC 1876(c)(3)(B) Name of Law: Social Security Act (Payments to Health Maintenance Organizations and Competitive Medical Plans)
   US Code: 18 USC 1851(g)(3)(B)(i) Name of Law: Social Security Act (Part C)
   US Code: 18 USC 1860D-1(b)(1)(B) Name of Law: Social Security Act (Part D)
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS20	Final or interim final rulemaking	80 FR 7912	02/12/2015

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 1918	01/10/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 7912	02/12/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Good Cause Processes (Sec. 417.460, 422.74, and 423.44)

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ICR Summary 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	8,376	0	0	8,376	0	0
Annual Time Burden (Hours)	4,188	0	0	4,188	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: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Not applicable, this is a new colelction.

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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]? No

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: 03/03/2015

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