Excepted Benefit Health Reimbursement Arrangements

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10727 EBHRA Supporting Statement 30d.docx	Supporting Statement A	Uploaded 2020-09-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241379	Excepted Benefit Health Reimbursement Arrangements (CMS-10727)		Modified

ICR Details

OMB Control No: 0938-1375	ICR Reference No: 202009-0938-007
Status: Received in OIRA	Previous ICR Reference No: 202004-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Excepted Benefit Health Reimbursement Arrangements
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: 09/10/2020

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	193,715	0
Time Burden (Hours)	1,488	0
Cost Burden (Dollars)	0	0

---

Abstract: In the proposed rule “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2021; Notice Requirement for Non-federal Governmental Plans”, HHS proposes to add a new paragraph (b)(3)(viii)(E) to 45 CFR 146.145 that would require excepted benefit health reimbursement arrangements (HRAs) offered by non-federal governmental plan sponsors to provide a notice that describes conditions pertaining to eligibility to receive benefits, annual or lifetime caps or other limits on benefits under the excepted benefit HRA, and a description or summary of the benefits. This notice would be provided no later than 90 days after the employee becomes a participant in the excepted benefit HRA and annually thereafter.

---

Authorizing Statute(s): US Code: 42 USC 300gg-91(c)(2)(c) Name of Law: Public Health Service Act Section 2791
   EO: EO 13813 Name/Subject of EO: Promoting Healthcare Choice and Competition Across the United States
  

Citations for New Statutory Requirements: US Code: 45 USC 146.146 Name of Law: Special rules relating to group health plans.

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AT98	Final or interim final rulemaking	85 FR 29164	05/14/2020

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Excepted Benefit Health Reimbursement Arrangements (CMS-10727)

---

ICR Summary of Burden

table that charts list 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	193,715	0	193,715	0	0	0
Annual Time Burden (Hours)	1,488	0	1,488	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: Total burden for the 3 years increased to 1,488 hours from 1,352. The annual burden hours for 2021 and 2022 were increased to 68 from 0 to account for instances where there will be substantive changes to plan benefits.

---

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

---

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: 09/10/2020

---