Good Cause Processes (CMS-10544)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Supporting Statement A CMS 10544 OMB 0938-1271-Final.docx	Supporting Statement A	Uploaded 2018-06-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215417	Good Cause Processes (Sec. 417.460, 422.74, and 423.44)		Modified

ICR Details

OMB Control No: 0938-1271	ICR Reference No: 201806-0938-003
Status: Active	Previous ICR Reference No: 201502-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-10544
Title: Good Cause Processes (CMS-10544)
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: 12/03/2018
	Date Received in OIRA: 06/14/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	36 Months From Approved
Responses	10,008	0	0
Time Burden (Hours)	6,665	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Beneficiaries are provided a protection outlined in regulation at 42 CFR 417.460, 422.74, and 423.44 that provides CMS with the ability to reinstate an individual's enrollment into a Medicare Advantage, Part D or cost plan in certain circumstances where the individual's non-payment of plan premiums was due to circumstances that the individual could not reasonably foresee or could not control, such as an unexpected hospitalization. This submission calculates the administrative cost by Medicare Advantage, Part D and cost plans to process such requests on behalf of CMS.

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Authorizing Statute(s): US Code: 18 USC 1851(g)(3)(B)(i) Name of Law: Social Security Act (Part C)
   US Code: 18 USC 1860D-1(b)(1)(B) Name of Law: Social Security Act (Part D)
   US Code: 18 USC 1876(c)(3)(B) Name of Law: Social Security Act (Payments to Health Maintenance Organizations and Competitive Medical 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:
	83 FR 10730	03/12/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 26691	06/08/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Good Cause Processes (Sec. 417.460, 422.74, and 423.44)

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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	10,008	0	0	1,632	0	8,376
Annual Time Burden (Hours)	6,665	0	0	2,477	0	4,188
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The higher costs are also the result of the increased number of plans that are dis-enrolling members for nonpayment of premiums and the number of beneficiaries dis-enrolled under these policies. Further, the cost associated with the beneficiary completing the request was also factored into the burden for 2017, whereas in 2015 this cost was not factored into the estimate.

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Annual Cost to Federal Government: $0

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]? No

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: 06/14/2018

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