State Permissions for Enrollment in Qualified Health Plans in the Federally Facilitated Exchange & Non-Exchange Entities (CMS-10650)

Forms and Documents

Document Name	Status
Form CMS-10650 ICRs Related to Non-Exchange Entities: Privacy and Security Policies and Procedures (§155.260(b)) Form and Instruction	New
Form CMS-10650 ICRs Related to the Ability of States to Permit Agents and Brokers to Assist Qualified Individuals, Qualified Employers, or Qualified Employees Enrolling in Qualified Health Plans in the Federally-fac Form and Instruction	New
CMS-10650-SPE QHPs FFE NEE Supporting Statement-Clean2018.docx Supporting Statement A	2018-02-21

IC Document Collections

IC ID	Document Title	Status
228027	ICRs Related to Non-Exchange Entities: Privacy and Security Policies and Procedures (§155.260(b)) Form and Instruction	New
228026	ICRs Related to the Ability of States to Permit Agents and Brokers to Assist Qualified Individuals, Qualified Employers, or Qualified Employees Enrolling in Qualified Health Plans in the Federally-fac Form and Instruction	New

ICR Details

OMB Control No: 0938-1349	ICR Reference No: 201708-0938-021
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: State Permissions for Enrollment in Qualified Health Plans in the Federally Facilitated Exchange & Non-Exchange Entities (CMS-10650)
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 with change	Conclusion Date: 02/21/2018
	Date Received in OIRA: 08/31/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved
Responses	104,165	0	0
Time Burden (Hours)	680,381	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Patient Protection and Affordable Care Act, Public Law 111-148, enacted on March 23, 2010, and the Health Care and Education Reconciliation Act, Public Law 111-152, enacted on March 30, 2010 (collectively, “Affordable Care Act”), expand access to health insurance for individuals and employees of small businesses through the establishment of new Affordable Insurance Exchanges (Exchanges), also called Marketplaces, including the Small Business Health Options Program (SHOP). The Exchanges, which became operational on January 1, 2014, enhance competition in the health insurance market, expand access to affordable health insurance for millions of Americans, and provide consumers with a place to easily compare and shop for health insurance coverage. This Information Collection Request (ICR) serves as the formal request for a new data collection clearance associated with the HHS Notice of Benefit and Payment Parameters for 2018 Final Rule (2018 Payment Notice). This ICR includes ICRs related to the ability of states to permit agents and brokers to assist qualified individuals, qualified employers, or qualified employees enrolling in Qualified Health Plans in the Federally Facilitated Exchange (§155.220) and ICRs related to non-exchange entities (§155.260).

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Authorizing Statute(s): US Code: 45 USC 156 Name of Law: Health Insurance Issuer Standards under the Affordable Care Act
   PL: Pub.L. 111 - 156 1312 Name of Law: Patient Protection and Affordable Care Act
   US Code: 45 USC 144 Name of Law: Requirements Relating to Health Insurance Coverage
   US Code: 45 USC 147 Name of Law: Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets
   US Code: 45 USC 155 Name of Law: Exchange Establishment Standards and Other Related Standards under the Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 156 1312 Name of Law: Patient Protection and Affordable Care Act
US Code: 45 USC 144 Name of Law: Requirements Relating to Health Insurance Coverage
US Code: 45 USC 147 Name of Law: Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets
US Code: 45 USC 155 Name of Law: Exchange Establishment Standards and Other Related Standards under the Affordable Care Act
US Code: 45 USC 156 Name of Law: Health Insurance Issuer Standards under the 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:
	82 FR 24350	05/26/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 40157	08/24/2017
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
ICRs Related to the Ability of States to Permit Agents and Brokers to Assist Qualified Individuals, Qualified Employers, or Qualified Employees Enrolling in Qualified Health Plans in the Federally-fac	CMS-10650	Appendix A: Data Elements for General Function of an Exchange
ICRs Related to Non-Exchange Entities: Privacy and Security Policies and Procedures (§155.260(b))	CMS-10650, CMS-10650	Agent Broker Privacy and Security Agreement ,   IM Agent Broker Privacy and Security Agreement

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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	104,165	0	104,165	0	0	0
Annual Time Burden (Hours)	680,381	0	680,381	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 collection of information.

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Annual Cost to Federal Government: $37,776

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 08/31/2017

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