State-based Marketplace Annual Reporting Tool (SMART)

Forms and Documents

Document Name	Status
Form CMS-10507 State-based Marketplace Annual Reporting Tool (SMART) Form and Instruction	Modified
CMS-10507 - SMART PRA Nonsubstantive change request.docx Justification for No Material/Nonsubstantive Change	2016-04-28
1-15-14 Supporting Statement_SMART.PDF Supporting Statement A	2014-02-02

IC Document Collections

IC ID	Document Title	Status
210245	State-based Marketplace Annual Reporting Tool (SMART) Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1244	ICR Reference No: 201604-0938-013
Status: Historical Active	Previous ICR Reference No: 201402-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: 21393
Title: State-based Marketplace Annual Reporting Tool (SMART)
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: 05/06/2016
	Date Received in OIRA: 04/28/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	07/31/2017	07/31/2017
Responses	19	0	19
Time Burden (Hours)	1,311	0	1,311
Cost Burden (Dollars)	0	0	0

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Abstract: The Affordable Care Act (ACA). The ACA creates new competitive private health insurance markets - referred to as State-based Marketplaces (SBMs) - that will give millions of Americans and small businesses access to affordable healthcare coverage. HHS provides oversight and monitoring of SBMs to ensure they maintain adequate operational systems. Effective and efficient oversight of Marketplaces will help ensure that affordable and quality health coverage is available to all Americans through monitoring, reporting, and oversight of financial and other Marketplace activities. The SMAR is the primary vehicle to insure comprehensive compliance with all reporting requirements contained in the ACA and applicable Federal Regulations. It is specifically called for in Section 1313(a)(1) of the Act which requires an SBM to keep an accurate accounting of all activities, receipts, and expenditures, and to submit a report annually to the Secretary concerning such accounting. Instructions governing specific facets of the activities covered by the report are contained both in the Act and in various sections of applicable Federal Regulations. CMS has designed the SMAR to reduce the data collection to the maximum extent possible. While it is intended as a comprehensive compliance review to ensure SBM are fulfilling their statutory requirements, very little additional data gathering is required to complete the form. The respondents can answer most questions by attestations and uploading existing documents. Respondents complete the report entirely online.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1313(a)(1) Name of Law: 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:
	78 FR 68851	11/15/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 5417	01/31/2014
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
State-based Marketplace Annual Reporting Tool (SMART)	CMS-10507	STATE-BASED MARKETPLACE ANNUAL REPORTING TOOL (SMART)

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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	19	19	0	0	0	0
Annual Time Burden (Hours)	1,311	1,311	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: This is a new information collection.

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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: 04/28/2016

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