Health Insurance Plans Research Study

Forms and Documents

Document Name	Status
Telephone Interview Script Form	New
Prevention and Wellness Survey Form	New
Appendix B_Published60DayFRN_Health Insurance Plans Research Study_10282014-25561.pdf Supplementary Document	2015-03-18
Appendix A_Section 301 Public Health Service Act_012115.docx Supplementary Document	2015-03-18
Supporting Statement B_031615.docx Supporting Statement B	2015-03-18
Supporting Statement A_031615.docx Supporting Statement A	2015-03-18

IC Document Collections

IC ID	Document Title	Status
215721	Telephone Interview Script Form	New
215720	Administrative Support Activity Other-non-instrument	New
215719	Key Health Plan Contact Activity Other-Non-instrument	New
215718	Prevention and Wellness Survey Form	New

ICR Details

OMB Control No: 0920-1079	ICR Reference No: 201503-0920-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 15CF
Title: Health Insurance Plans Research Study
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: 08/17/2015
	Date Received in OIRA: 03/31/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	36 Months From Approved
Responses	459	0	0
Time Burden (Hours)	234	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The primary objective of this study is to conduct a systematic examination of prevention and wellness programs implemented by health insurance plans for their commercial population, including best practices and challenges encountered.

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Authorizing Statute(s): US Code: 42 USC 301 [241] Name of Law: Public Health Service Act
  

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 64197	10/28/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 16390	03/27/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Key Health Plan Contact Activity
Administrative Support Activity
Telephone Interview Script	none	Sample Interview Questions
Prevention and Wellness Survey	none	Survey

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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	459	0	0	459	0	0
Annual Time Burden (Hours)	234	0	0	234	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: No

Burden Reduction Due to:

Short Statement: This is new data collection request.

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Annual Cost to Federal Government: $149,957

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]? 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: 03/31/2015

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