Review and Approval Process for Waivers for State Innovation (CMS-10383)

Forms and Documents

Document Name	Status
CMS-10383 - Supporting Statement Part A.pdf Supporting Statement A	2019-12-30
CMS-10383 - APPENDIX A- Comment response document.pdf Supplementary Document	2019-12-30

IC Document Collections

IC ID	Document Title	Status
239117	Review and Approval Process for Waivers for State Innovation	New

ICR Details

OMB Control No:	ICR Reference No: 201912-0938-023
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Review and Approval Process for Waivers for State Innovation (CMS-10383)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/09/2020

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	12	0
Time Burden (Hours)	4,016	0
Cost Burden (Dollars)	0	0

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Abstract: Under section 1332 of the Patient Protection and Affordable Care Act (PPACA) secretaries are required to establish a process for the submission of an application for a section 1332 State Innovation waiver (also now referred to as a State Relief and Empowerment Waiver or section 1332 waiver), including a process for public notice and comment at the state and federal levels that is sufficient to ensure a meaningful level of public input. This information collection request would establish requirements pertaining to the provisions required under section 1332.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1332 Name of Law: Waiver for State innovation.
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1332 Name of Law: Waiver for State innovation.

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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:
	84 FR 39851	08/12/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 69380	12/18/2019
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Review and Approval Process for Waivers for State Innovation

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ICR Summary of Burden

	Total Request	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	12	0	12	0	0	0
Annual Time Burden (Hours)	4,016	0	4,016	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: $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? No

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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: 01/09/2020

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