Compliance with Individual and Group Market Reforms under Title XXVII of the Public Health Service Act (CMS-10430)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10430 - Supporting Statement 30d.docx	Supporting Statement A	Uploaded 2025-08-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43664	Information Collection Requirements for Compliance with Individual and Group Market Reforms under Title XXVII of the Public Health Service Act	Other-Notice	Modified

ICR Details

OMB Control No: 0938-0702	ICR Reference No: 202508-0938-011
Status: Received in OIRA	Previous ICR Reference No: 202409-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Compliance with Individual and Group Market Reforms under Title XXVII of the Public Health Service Act (CMS-10430)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/11/2025

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2026
Responses	12,891	51,385
Time Burden (Hours)	2,408	1,786
Cost Burden (Dollars)	0	0

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Abstract: Sections 2723 and 2761 of the Public Health Service Act (PHS Act) direct the Centers for Medicare and Medicaid Services (CMS) to enforce a provision (or provisions) of title XXVII of the PHS Act (including the implementing regulations in parts 144, 146, 147, and 148 of title 45 of the Code of Federal Regulations) with respect to health insurance issuers when a state has notified CMS that it has not enacted legislation to enforce or that it is not otherwise enforcing a provision (or provisions) of the group and individual market reforms with respect to health insurance issuers, or when CMS has determined that a state is not substantially enforcing one or more of those provisions. This collection of information includes requirements that are necessary for CMS to conduct compliance review activities.

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Authorizing Statute(s): US Code: 42 USC 300gg-61 Name of Law: Individual Market Rules
   PL: Pub.L. 111 - 148 Title I Name of Law: Affordable Care Act
   US Code: 42 USC 300gg-23 Name of Law: Individual and Group Market Reforms
   US Code: 42 USC 241 Name of Law: Research and investigations generally
   PL: Pub.L. 105 - 277 Title IX Name of Law: The Women's Health and Cancer Rights Act of 1998
   PL: Pub.L. 104 - 204 Title VI Name of Law: Newborns' and Mothers' Health Protection Act of 1996
   PL: Pub.L. 104 - 191 Title I Name of Law: Health Insurance Portability and Accountability Act of 1996 (HIPAA)
   PL: Pub.L. 110 - 343 Title V Name of Law: Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008
   PL: Pub.L. 110 - 223 Title I Name of Law: Genetic Information Nondiscrimination Act of 2008
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AU93	Final or interim final rulemaking	89 FR 77586	09/23/2024

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Federal Register Notices & Comments

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
Information Collection Requirements for Compliance with Individual and Group Market Reforms under Title XXVII of the Public Health Service Act

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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	12,891	51,385	0	0	-38,494	0
Annual Time Burden (Hours)	2,408	1,786	0	0	622	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: The estimated burden related to the Federal collection and review of issuers’ form filings has increased by 812 hours (from 329 hours to 1,141 hours) due to an increase in the number of issuers submitting forms for CMS’ review (from 47 in 2021 to 163 in 2024). The estimated burden related to the issuer disclosure to small employers has decreased by 38 hours (from 682 hours to 644 hours) due to a decrease in the estimated number of issuers in the small group market (from 341 to 322). The estimated burden related to opt-out notices has decreased by 152 hours (from 175 hours to 23 hours) due to a decrease in the estimated number of plans opting out (from 350 to 46). Therefore, total burden hours have increased by 622 hours (from 1,786 to 2,408). 1

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Annual Cost to Federal Government: $3,788,899

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: 08/11/2025

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