Estimation of Improper Payments of the Advanced Payment of Premium Tax Credit (APTC) in State Exchanges under the Affordable Care Act (CMS-10794)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10794 State Exchange Improper Payment Measurement (SEIPM) Data Request Form	Form and Instruction	New	Available
CMS - 10794 - Supporting Statement Final.docx	Supporting Statement A	Uploaded 2022-01-11	Repair queued
CMS - 10794 - Supporting Statement B Final.docx	Supporting Statement B	Uploaded 2022-01-11	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
251110	State Exchange Improper Payment Measurement (SEIPM) Data Request Form	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202201-0938-017
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO -10794
Title: Estimation of Improper Payments of the Advanced Payment of Premium Tax Credit (APTC) in State Exchanges under the Affordable Care Act (CMS-10794)
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: 01/21/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	18	0
Time Burden (Hours)	12,942	0
Cost Burden (Dollars)	0	0

---

Abstract: The PIIA requires executive agencies to report on Federal programs susceptible to significant improper payments. The APTC program was identified as a Federal program susceptible to significant improper payments. To comply with the requirements of the PIIA, CMS/OFM proposes to collect information from State Exchanges to identify, measure, report, and reduce errors made by State Exchanges in determining eligibility for APTC payments. Currently in operation are eighteen State Exchanges, which do not use the Federal platform to perform eligibility and enrollment determinations.

---

Authorizing Statute(s): US Code: 31 USC 3301 et seq; 3352 Name of Law: Payment Integrity Information Act of 2019
   US Code: 42 USC 18033 and 18041 Name of Law: Patient Protection and Affordable Care Act of 2010
  

Citations for New Statutory Requirements: US Code: 45 USC 155.1510 Name of Law: Public Welfare

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AU65	Proposed rulemaking	87 FR 584	01/05/2022

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
State Exchange Improper Payment Measurement (SEIPM) Data Request Form	CMS-10794	State Exchange Improper Payment Measurement Data Request Form

---

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	18	0	18	0	0	0
Annual Time Burden (Hours)	12,942	0	12,942	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.

---

Annual Cost to Federal Government: $2,256,450

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: 01/21/2022

---