Small Business Health Options Program (SHOP) Effective Date and Termination Notice Requirements (CMS-10555)

Forms and Documents

Document Name	Status
Form CMS-10555 SHOP Satisfaction Surveys Form and Instruction	New
CMS-10555 - Supporting Statement - Part B.doc Supporting Statement B	2015-12-17
SHOP Notices 30-Day Supporting Statement A 10022015 - FINAL.PDF Supporting Statement A	2015-12-17

IC Document Collections

IC ID	Document Title	Status
219294	SHOP Satisfaction Surveys Form and Instruction	New
219292	Termination of SHOP Enrollment	New
219290	Enrollment of Employees into QHPs under SHOP	New

ICR Details

OMB Control No: 0938-1303	ICR Reference No: 201512-0938-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Small Business Health Options Program (SHOP) Effective Date and Termination Notice Requirements (CMS-10555)
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: 04/04/2016
	Date Received in OIRA: 12/18/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2019	36 Months From Approved
Responses	5,770	0	0
Time Burden (Hours)	49,165	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 155.720 requires that for plan years beginning before January 1, 2017, the Small Business Health Options Program (SHOP) must ensure that a QHP issuer notifies a qualified employee enrolled in a QHP of the effective date of his or her coverage. For plan years beginning on or after January 1, 2017, the SHOP must ensure that a QHP issuer notifies any enrollee and new enrollees pursuant to Section 156.285, enrolled in a QHP through the SHOP of the effective date of coverage. Section 155.735 requires if any enrollee’s coverage through the SHOP is terminated due to non-payment of premiums or a loss of the enrollee’s or employer group’s eligibility to participate in the SHOP, the SHOP must notify the enrollee or the qualified employer of the termination of such coverage. In the termination of coverage the SHOP must include the termination date and reason for termination to the enrollee or qualified employer. To aid in understanding levels of awareness and customer services needs associated with SHOP, CMS will engage in collecting primary qualitative and quantitative research from Exchange target audiences. CMS has designed three surveys to target different audiences, specifically agents and brokers, employers, and employees. These surveys are part of a broader data collection effort designed to support the program goal to improve customer satisfaction for people and small businesses that are eligible for coverage through the SHOP. The brief surveys will provide CMS a rough indication of the types of outreach and marketing that will be needed to enhance awareness of and knowledge of SHOP, as well as how to improve the consumer experience. Cognitive testing was performed with individuals who would be target participants in the surveys to ensure that question intent and response options are not confusing or frustrating to potential participants.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1311 Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1311 Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)

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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:
	80 FR 12488	03/09/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 77353	12/14/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Enrollment of Employees into QHPs under SHOP
Termination of SHOP Enrollment
SHOP Satisfaction Surveys	CMS-10555, CMS-10555, CMS-10555	SHOP Notices Agents-Brokers Survey ,   SHOP Notices - Employer Survey ,   SHOP Notices - Employee Survey.docx

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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	5,770	0	5,770	0	0	0
Annual Time Burden (Hours)	49,165	0	49,165	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: This is a new information collection request.

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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: 12/18/2015

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