Payment Collections Operations Contingency Plan (CMS-10515)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10515 Monthly Data Submission Accuracy Certification Form	Form and Instruction	Modified	Available
Form CMS-10515 CMS Enrollment Payment Data Template	Form and Instruction	Modified	Available
CMS-10515 - 60-Day Public Comment.docx	Public Comments	Uploaded 2025-10-01	Available
PRA 0938-1217 60-Day Public Comment Response.pdf_508 Compliant.pdf	Supplementary Document	Uploaded 2025-10-01	Repair queued
CMS-10515 Supporting Statement 30-day.docx	Supporting Statement A	Uploaded 2025-10-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209729	Monthly Data Submission Accuracy Certification Form	Form and Instruction	Modified	Monthly Data Submission Accuracy Certification Form
209728	Monthly Data Reports	Form and Instruction	Modified	CMS Enrollment Payment Data Template

ICR Details

OMB Control No: 0938-1217	ICR Reference No: 202508-0938-018
Status: Received in OIRA	Previous ICR Reference No: 202204-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO - 10515
Title: Payment Collections Operations Contingency Plan (CMS-10515)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/01/2025

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	300	0
Time Burden (Hours)	1,525	0
Cost Burden (Dollars)	0	0

---

Abstract: Under sections 1401, 1411, and 1412 of the Affordable Care Act and 45 CFR part 155 subpart D, an Exchange makes an advance determination of tax credit eligibility for individuals who enroll in QHP coverage through the Exchange and seek financial assistance. Using information available at the time of enrollment, the Exchange determines whether the individual meets the income and other requirements for advance payments and the amount of the advance payments that can be used to pay premiums. Advance payments are made periodically under section 1412 of the Affordable Care Act to the issuer of the QHP in which the individual enrolls. Section 1402 of the Affordable Care Act provides for the reduction of cost sharing for certain individuals enrolled in a QHP through an Exchange, and section 1412 of the Affordable Care Act provides for the advance payment of these reductions to issuers. The statute directs issuers to reduce cost sharing for essential health benefits for individuals with household incomes between 100 and 400 percent of the Federal poverty level (FPL) who are enrolled in a silver level QHP through an individual market Exchange and are eligible for advance payments of the premium tax credit. Health insurance issuers will manually enter enrollment and payment data into a Microsoft Excel-based spreadsheet, and submit the information to HHS. The data collection will be used by HHS to make payments or collect charges from issuers under the following programs: advance payments of the premium tax credit, advanced cost-sharing reductions, and Marketplace user fees. HHS will use the information collected to make payments and collect charges in January 2014 and for a number of months thereafter, as may be required based on HHS's operational progress.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 1402 Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 111 - 148 1401 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1401 Name of Law: Patient Protection and Affordable Care Act
PL: Pub.L. 111 - 148 1402 Name of Law: Patient Protection and Affordable Care Act

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 99871	12/11/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 30939	07/11/2025
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Monthly Data Reports	CMS-10515	CMS Enrollment Payment Data Template
Monthly Data Submission Accuracy Certification Form	CMS-10515	Monthly Data Submission Accuracy Certification 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	300	0	0	0	-300	600
Annual Time Burden (Hours)	1,525	0	0	0	-1,526	3,051
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 burden hours have decreased by 1,526 hours (3,051 hours to 1,525 hours). In January 2016, HHS implemented an automated payment approach (PBP) to determine an issuer’s advance payment using enrollment and payment data in the FFE. As of April 2016, all FFE and SBE-FP issuers have fully transitioned to the PBP process. In the previous version of this supporting statement, we estimated 50 issuers would be required to use a manual methodology to transmit enrollment and payment data in transitioning SBEs, but based on program experience over the past few years, we now estimate that only 25 issuers will be required to use the manual method (the Enrollment and Payment Data template) annually to transmit information via a manual system. Additionally, issuers will not be required to establish new systems to complete their enrollment and payment forms because their systems have already been established by the SBE, and the forms are not changing. Furthermore, as of October 2017, because of the discontinuation of CSR payments from HHS to issuers, the cost-sharing field in the dataset is no longer required to be submitted and may be left blank. Finally, we expect this burden estimate to apply annually as FFE and SBE-FP States transition to SBEs.

---

Annual Cost to Federal Government: $3,887

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: 10/01/2025

---