Payment Collections Operations Contingency Plan (CMS-10515)

ICR 202508-0938-018

OMB: 0938-1217

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Supplementary Document
2025-10-01
Supporting Statement A
2025-10-01
IC Document Collections
ICR Details
0938-1217 202508-0938-018
Received in OIRA 202204-0938-012
HHS/CMS CCIIO - 10515
Payment Collections Operations Contingency Plan (CMS-10515)
Reinstatement with change of a previously approved collection   No
Regular 10/01/2025
  Requested Previously Approved
36 Months From Approved
300 0
1,525 0
0 0

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.

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
  
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

Not associated with rulemaking

  89 FR 99871 12/11/2024
90 FR 30939 07/11/2025
Yes

  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
No
No
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.

$3,887
No
    No
    No
Yes
No
No
No
Jamaa Hill 301 492-4190

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/01/2025


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