Essential Community Provider Data Collection to Support QHP Certification (CMS-10561)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10561 Application and Annual Renewal Form	Form and Instruction	Modified	Available
CMS-10561 - Appendix C - 60-Day Public Comments.pdf	Public Comments	Uploaded 2025-05-14	Available
CMS-10561 - Appendix B - 60-Day Comment Response.pdf	Supplementary Document	Uploaded 2026-02-19	Available
CMS-10561 - Supporting Statementf.pdf	Supporting Statement A	Uploaded 2026-02-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218061	Essential Community Provider Petition	Form and Instruction	Modified	Application and Annual Renewal Form
218061	Essential Community Provider Petition	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1295	ICR Reference No: 202602-0938-016
Status: Received in OIRA	Previous ICR Reference No: 202206-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Essential Community Provider Data Collection to Support QHP Certification (CMS-10561)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/19/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	19,020	0
Time Burden (Hours)	14,742	0
Cost Burden (Dollars)	0	0

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Abstract: For plan years beginning on or after January 1, 2017, Health and Human Services (HHS) intends to collect more complete provider data for inclusion on the HHS Essential Community Provider (ECP) list to ensure a more accurate reflection of the universe of qualified available ECPs in a given service area that can be counted toward an issuer's satisfaction of the ECP standard. The HHS will collect data on qualified and available ECPs from providers. Providers will submit an ECP petition to be added to the HHS ECP list or provide required missing data fields to remain on the list. The degree of provider participation in this data collection effort through the ECP provider petition will help inform HHS's future proposals for counting issuers' ECP write-ins toward satisfaction of the ECP standard.

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Authorizing Statute(s): PL: Pub.L. 111 - 155 1311(c)(1)(C) Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 115 1311(c)(1)(c) Name of Law: Affordable Care Act

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 16685	04/21/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 40832	08/21/2025
Did the Agency receive public comments on this ICR? Yes

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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
Essential Community Provider Petition	CMS-10561	Application and Annual Renewal Form

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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	19,020	0	0	0	6,612	12,408
Annual Time Burden (Hours)	14,742	0	0	0	5,322	9,420
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: There is an overall increase in burden from the 2022 PRA package because of an overall increase in the number of providers that will be subject to the application renewal requirement in 2025. The total number of respondents have increased from 12,408 respondents to 19,020, an increase of 6,612. The number of burden hours increased from 3,140 to 4,914 (14,742 for 3 years), an increase of 1,773.75 hours (+5,322 hours for 3-years). The estimated annual cost increased from $187,238.28 to $312,514.50, an increase of $125,276.22.

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Annual Cost to Federal Government: $314,961

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: 02/19/2026

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