Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel - CAC (CMS-10494)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10494 Recertification request by organization	Form and Instruction	Modified	Available
Form CMS-10494 155.225(b)(1) Organization designation by Exchange Information Updates	Form and Instruction	Modified	Available
Form CMS-10494 155.225(d)(1) and (7) Training Quality Optional Questionnaire	Form and Instruction	Modified	Available
Form CMS-10494 155.225(d)(1) - Training certificate retention	Form and Instruction	Modified	Available
Form CMS-10494 155.225(d)(1) - Training certificate proof	Form and Instruction	Modified	Available
Form CMS-10494 155.225(d)(1) - Training Registration	Form and Instruction	Modified	Available
Form CMS-10494 155.225(b)(1)(ii) - Identification number record retention	Form and Instruction	Modified	Available
Form CMS-10494 155.225(b)(1)(ii) - Issuance of unique registration identification number	Form and Instruction	Modified	Available
Form CMS-10494 155.225(d)(2) and (f) (CAC authorization to consumer)	Form and Instruction	Modified	Available
Form CMS-10494 155.225(b)(1)(i) (certificate issuance)	Form and Instruction	Modified	Available
Form CMS-10494 155.225(b)(1) (organization follow-up for application)	Form and Instruction	Modified	Repair queued
Form CMS-10494 155.225(b)(1) (organization designation by Exchange)	Form and Instruction	Modified	Available
CMS-10494 Supporting Statement FinalS.doc	Supporting Statement A	Uploaded 2017-03-13	Available
CMS-10494 Supporting Statement Part Bx.pdf	Supporting Statement B	Uploaded 2017-03-06	Available
CMS-10494 - Appendix M Response_to_Public_Comments 508MM.PDF	Supplementary Document	Uploaded 2016-03-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
220357	?155.225 (b)(ii) (performance tracking form by organization)		Unchanged
220355	?155.225 (b)(ii) (reporting performance data by certified application counselor)		Unchanged
220354	?155.225 (b)(ii) (recordkeeping performance data by organization)		Unchanged
220353	?155.225 (b)(1)(iii)- (reporting by organizations)		Unchanged
220352	?155.225 (b)(1)(iii)- (review by State Exchange)		Unchanged
220351	?155.225(b)(1)(iii)-(review byFederally-facilitatedExchange)		Unchanged
216275	Recertification Training		Unchanged
216274	Recertification request by organization	Form and Instruction	Modified
216273	CAC Recertification		Unchanged
216272	155.225(b)(1) Organization designation by Exchange Information Updates	Form and Instruction	Modified
216271	155.225(d)(1) and (7) Training Quality Optional Questionnaire	Form and Instruction	Modified
208217	155.225(d)(1) - Training certificate retention	Form and Instruction	Modified
208216	155.225(d)(1) - Training certificate proof	Form and Instruction	Modified
208215	155.225(d)(1) - Training Registration	Form and Instruction	Modified
208214	155.225(b)(1)(ii) - Identification number record retention	Form and Instruction	Modified
208213	155.225(b)(1)(ii) - Issuance of unique registration identification number	Form and Instruction	Modified
207940	155.225(d)(2) and (f) (CAC authorization to consumer)	Form and Instruction	Modified
207939	155.225(d)(2) and (f) (organization record of authorization)		Unchanged
207938	155.225(b)(1)(i) (certificate issuance)	Form and Instruction	Modified
207937	155.225(b)(1) (organization list)		Unchanged
207874	155.225(b)(1)(i) (organization attestation)		Unchanged
207873	155.225(b)(1) (organization follow-up for application)	Form and Instruction	Modified
207872	155.225(b)(1) (organization designation by Exchange)	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1205	ICR Reference No: 201703-0938-005
Status: Active	Previous ICR Reference No: 201603-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel - CAC (CMS-10494)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/27/2017
	Date Received in OIRA: 03/13/2017
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	05/31/2018
Responses	4,851,018	0	4,676,018
Time Burden (Hours)	855,821	0	693,701
Cost Burden (Dollars)	0	0	0

---

Abstract: Section 1413 of the Affordable Care Act directs the Secretary of HHS to establish, subject to minimum requirements, a streamlined enrollment system for qualified health plans offered through the Exchange and insurance affordability programs. In addition, section 1321(a)(1) of the Affordable Care Act directs and authorizes the Secretary to issue regulations setting standards for meeting the requirements under title I of the Affordable Care Act, with respect to, among other things, the establishment and operation of Exchanges. Pursuant to this authority, regulations establishing the certified application counselor program are being finalized at 45 CFR 155.225. Specifically, 45 CFR 155.225(a) requires an Exchange to establish a certified application counselor program that complies with the requirements of the rule. Section155.225(b)(1) allows each Exchange to designate certain organizations, including organizations designated by state Medicaid or CHIP agencies, which will certify their staff and volunteers to act as certified application counselors. In accordance with 45 CFR 155.225(b)(2), Exchanges may choose to certify directly individuals who seek to act as certified application counselors, designate certain organizations which will certify staff or volunteers to perform application services, or do both.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 1413 Name of Law: Streamlining of procedures for enrollment through an exchange
   PL: Pub.L. 111 - 148 1321(a)(1)(A) and (D) Name of Law: State Flexibility in Operation and Enforcement of Exchanges and Related Requirements
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1321(A) and (D) Name of Law: State Flexibility in Operation and Enforcement of Exchanges and Related Requirements
PL: Pub.L. 111 - 148 1413 Name of Law: Streamlining of procedures for enrollment through an exchange

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS57	Final or interim final rulemaking	81 FR 12203	03/16/2016

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 23

table that charts list of burden

IC Title	Form No.	Form Name
155.225(b)(1)(ii) - Issuance of unique registration identification number	CMS-10494	Registration Portal
155.225(b)(1)(ii) - Identification number record retention	CMS-10494	Registration
155.225(d)(1) - Training Registration	CMS-10494	Registration
155.225(d)(1) - Training certificate proof	CMS-10494	Registration
155.225(b)(1) (organization list)
155.225(d)(1) - Training certificate retention	CMS-10494	Registration
§155.225(b)(1)(iii)-(review byFederally-facilitatedExchange)
§155.225 (b)(1)(iii)- (reporting by organizations)
§155.225 (b)(ii) (recordkeeping performance data by organization)
§155.225 (b)(ii) (reporting performance data by certified application counselor)
§155.225 (b)(ii) (performance tracking form by organization)
§155.225 (b)(1)(iii)- (review by State Exchange)
Recertification Training
155.225(d)(1) and (7) Training Quality Optional Questionnaire	CMS-10494	Training Quality Questionnaire
155.225(b)(1) Organization designation by Exchange Information Updates	CMS-10494	Find Local Help Instrument
CAC Recertification
Recertification request by organization	CMS-10494	Recertification Request Form
155.225(d)(2) and (f) (CAC authorization to consumer)	CMS-10494, CMS-10494, CMS-10494	CAC Agreement ,   Model Authorization Form (English) ,   Model Authorization Form (Spanish)
155.225(b)(1) (organization designation by Exchange)	CMS-10494	Individual CAC Agreement
155.225(b)(1) (organization follow-up for application)	CMS-10494	CAC Organization Application
155.225(b)(1)(i) (organization attestation)
155.225(b)(1)(i) (certificate issuance)	CMS-10494, CMS-10494, CMS-10494	Training Certificate ,   Training Certificate (English) ,   Sample Certification Certificate (Spanish)
155.225(d)(2) and (f) (organization record of authorization)

---

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	4,851,018	4,676,018	145,000	0	30,000	0
Annual Time Burden (Hours)	855,821	693,701	154,620	0	7,500	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 revised collection increased the total time burden by 162,120 hours, from 693,701 hours to 855,821 hours. The change in burden is mainly due to newly proposed requirements associated with tracking performance data and information by each certified application counselor and designated organization. There are additional requirements being proposed related to reporting of performance data and information by each certified application counselor organization to an Exchange, and the review of that data and information by the Exchange to which it has been submitted. CMS inadvertently overlooked the burden associated with CMS' review of the optional training quality user questionnaire and is additional burden associated with the collection in this proposed submission.

---

Annual Cost to Federal Government: $100,660

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

---

Common Form ICR:  No

---

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: 03/13/2017

---