Health Equity Technical Assistance Monitoring and Tracking (CMS-10669)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10669_Supporting_Statement_Part_A.doc	Supporting Statement A	Uploaded 2018-07-20	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
232326	Health Equity Technical Assistance Monitoring and Tracking	Other-Email Template	New

ICR Details

OMB Control No:	ICR Reference No: 201807-0938-007
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS/OMH
Title: Health Equity Technical Assistance Monitoring and Tracking (CMS-10669)
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: Not subject to PRA	Conclusion Date: 12/03/2018
	Date Received in OIRA: 07/23/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The information will be used to identify commonly asked questions, and improve Technical Assistance (TA) and resources provided by the CMS Office Minority Health. The information will be collected from the requests submitted to the mailbox, telephone conversations with the customer, and any products voluntarily shared with TA staff by the customer. Staff will record relevant information obtained from mailbox correspondence or from call notes into a spreadsheet. All information collected will be related to the health equity request. We propose to use this information to describe how the health equity TA process is being used and general information on the type of TA provided. For example, we may share information among CMS and CMS-contractors to assess the utility of existing CMS resources and identify gaps and opportunities for improvements and future resources and products; we may use this information to demonstrate the reach of our technical assistance, providing general information about the number and type of technical assistance requested and provided in public reports.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 5001 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 5001 Name of Law: 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:
	83 FR 19288	05/02/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 32874	07/16/2018
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
Health Equity Technical Assistance Monitoring and Tracking

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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 information collection request.

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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]? 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: 07/23/2018

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