Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions (CMS-10466)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10466 Application for Exemptions Religious Sects or Divis	Form and Instruction	Modified	Available
Form CMS-10466 Application Exemption - Hardships	Form and Instruction	Modified	Available
Form CMS-10466 Exemption Application - Shared Responsibility SBM's	Form and Instruction	Modified	Available
Form CMS-10466 Application Exemptions Shared Responsibility for FFM's	Form and Instruction	Modified	Available
CMS-10466 - Exemptions Application Supporting Statement fINAL.docx	Supporting Statement A	Uploaded 2017-02-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208103	Agreements		Modified
208102	Periodic Electronic Notifications		Modified
208101	Redeterminations		Modified
205756	Verification of New and Changed Applications		Modified
205755	Eligibility Notices		Modified
205754	Application Development		Modified
205753	Exemption Applications - Eligibility for Exemptions	Form and Instruction	Modified	Application for Exemptions Religious Sects or Divis
205753	Exemption Applications - Eligibility for Exemptions	Form and Instruction	Modified	Application Exemption - Hardships
205753	Exemption Applications - Eligibility for Exemptions	Form and Instruction	Modified	Exemption Application - Shared Responsibility SBM's
205753	Exemption Applications - Eligibility for Exemptions	Form and Instruction	Modified	Application Exemptions Shared Responsibility for FFM's

ICR Details

OMB Control No: 0938-1190	ICR Reference No: 201702-0938-001
Status: Historical Active	Previous ICR Reference No: 201402-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No: 21516
Title: Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions (CMS-10466)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/20/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/10/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved
Responses	2,000,072	0	0
Time Burden (Hours)	555,752	0	0
Cost Burden (Dollars)	600,000	0	0

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Abstract: On March 23, 2010, the President signed into law H.R. 3590, the Patient Protection and Affordable Care Act, Public Law 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. 111-152, collectively referred to as “The Affordable Care Act.” The Affordable Care Act expands access to health insurance for individuals and employees of small businesses through the establishment of new Affordable Insurance Exchanges (Exchanges), including the Small Business Health Options Program (SHOP). The Health Benefits Exchanges established by the Affordable Care Act facilitate the enrollment of qualified individuals into Qualified Health Plans (QHPs). Section 1501(b) of the Affordable Care Act added section 5000A of the Internal Revenue Code (the Code) to a new chapter 48 of subtitle of the Code effective for months beginning after December 31, 2013. Section 5000A of the Code requires that nonexempt individuals either maintain minimum essential coverage or make a shared responsibility payment, includes standards for the calculation of the shared responsibility payment, describes categories of individuals who may qualify for an exemption from the shared responsibility payment, and provides the definition of minimum essential coverage. Section 1311(d)(4)(H) of the Affordable Care Act specifies that the Exchange will, subject to section 1411 of the Affordable Care Act, grant certifications of exemption from the shared responsibility payment specified in section 5000A of the Code. Section 1411(a)(4) of the Affordable Care Act provides that the Secretary of Health and Human Services (the Secretary) will establish a program for determining whether a certification of exemption from the shared responsibility requirement and penalty will be issued by an Exchange under section 1311(d)(4)(H). Section 1321 of the Affordable Care Act discusses state flexibility in the operation and enforcement of Exchanges and related requirements. Section 1321(a) provides broad authority for the Secretary to establish standards and regulations to implement the statutory requirements related to Exchanges and other components of title I of the Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010. CMS is publishing the criteria needed to determine eligibility for certifications of exemption and updated applications for exemptions as processed by the Marketplace. CMS developed this PRA package as part of an effort to solicit feedback from key stakeholders.

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Authorizing Statute(s): PL: Pub.L. 111 - 152 1413 Name of Law: Health Care and Education Reconciliation Act of 2010
   PL: Pub.L. 111 - 148 1311 Name of Law: Affordable choices of health benefit plans.
  

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:
	81 FR 73405	10/25/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 95615	12/28/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
Agreements
Application Development
Eligibility Notices
Exemption Applications - Eligibility for Exemptions	CMS-10466, CMS-10466, CMS-10466, CMS-10466	Application Exemptions Shared Responsibility for FFM's ,   Exemption Application - Shared Responsibility SBM's ,   Application Exemption - Hardships ,   Application for Exemptions Religious Sects or Divis
Periodic Electronic Notifications
Redeterminations
Verification of New and Changed Applications

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ICR Summary of Burden

table that charts list 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	2,000,072	0	0	0	-10,000,036	12,000,108
Annual Time Burden (Hours)	555,752	0	0	0	-2,707,853	3,263,605
Annual Cost Burden (Dollars)	600,000	0	0	0	0	600,000

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: We have updated the information request based on the number of applications received during the first three years of the program. Instead of 12 million total applicants to both the Exchange and the IRS, we are estimating a total of 2 million applicants for exemptions from the Exchange each year beginning in the 2017 tax year. Additionally, the estimated number of statebased Exchanges has decreased from 18 to 12. These factors have reduced the total burden from 3,263,605 hours to 555,752 hours.

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Annual Cost to Federal Government: $111,775

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: 02/10/2017

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