Consumer Assistance Program Grants (CMS-10333)

Forms and Documents

Document Name	Status
Form CMS-10333 Data Collection Report (Quarterly and Annual Reports) Form and Instruction	Modified
Form CMS-10333 Data Collection Report (Initial Submission) Form and Instruction	Modified
CMS-10333 CMS Response to Public Comments.pdf Supplementary Document	2012-12-11
CMS-10333 - Supporting Statementis.doc Supporting Statement A	2016-11-04

IC Document Collections

IC ID	Document Title	Status
193768	Data Collection Report (Quarterly and Annual Reports) Form and Instruction	Modified
193767	Data Collection Report (Initial Submission) Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1097	ICR Reference No: 201611-0938-003
Status: Historical Active	Previous ICR Reference No: 201212-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Consumer Assistance Program Grants (CMS-10333)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/18/2016
	Date Received in OIRA: 11/08/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2019	36 Months From Approved	11/30/2016
Responses	459	0	560
Time Burden (Hours)	11,883	0	16,184
Cost Burden (Dollars)	0	0	0

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Abstract: Pursuant to section 2793(d) of the Public Health Services Act (PHSA), as amended by Section 1002 of the ACA, as a condition for receiving the consumer assistance program grant, programs must collect and report data to the Secretary on the types of problems and inquiries encountered by consumers. Accordingly, program staff will need a system to maintain case files that will track these types of problems and inquiries. Problems and inquiries will be summarized and will be reported to HHS. By law, the user of the summary data is the Secretary of HHS and will be used for oversight. Further, ACA dictates that the Secretary will share these reports with the Department of Labor and Treasury, and with State insurance regulators for use in enforcement.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1002 Name of Law: Health Insurance Consumer Information
  

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:
	80 FR 67406	11/02/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 3146	01/20/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Data Collection Report (Initial Submission)	CMS-10333	Appendix 1
Data Collection Report (Quarterly and Annual Reports)	CMS-10333, CMS-10333	Appendix 3 ,   Appendix 2

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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	560	0	0	-101	0
Annual Time Burden (Hours)	11,883	16,184	0	0	-4,301	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: Reporting requirements have not changed and there are no changes to the estimated annual time burden per respondent, except to correct previous calculation errors. However, due to changes in 2014 legislation, specifically, 2793 of the PHS Act (Section 1002 of the ACA), the number of respondents is decreasing from 56 to 51 respondents, excluding five Territories. The Act excludes all five territories as they no longer fall under the definition of “state”. As of 2014, these respondents are no longer eligible to apply for any programs under the ACA. As a result, the total annual time burden estimate hours decreased from 16,184 to 11,883. In addition, the estimated annual cost burden is increased per respondent to account for wage inflation, but the overall annual cost burden is decreased due to fewer possible grantees.

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Annual Cost to Federal Government: $30,874

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: 11/08/2016

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