Data Submission for the Federally-facilitated Exchange User Fee Adjustment (CMS-10492)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10492 Notice of Availability of Separate Contraception Payments from Fully Insured Issuers	Form and Instruction	Modified	Available
Form CMS-10492 Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services	Form and Instruction	Modified	Available
Form CMS-10492 Issuers' Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment	Form and Instruction	Modified	Available
Form CMS-10492 Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services	Form and Instruction	Modified	Available
Form CMS-10492 Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment	Form and Instruction	Modified	Available
CMS-10492 - 60-day comment.docx	Public Comments	Uploaded 2026-06-10	Available
CMS-10492 - Response to comments.docx	Supplementary Document	Uploaded 2026-06-10	Available
CMS-10492 - Supporting Statement.docx	Supporting Statement A	Uploaded 2026-06-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
217425	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)	Form and Instruction	Modified	Notice of Availability of Separate Contraception Payments from Fully Insured Issuers
217424	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer)	Form and Instruction	Modified	Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services
217424	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer)	Form and Instruction	Modified	Issuers' Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment
217422	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs)	Form and Instruction	Modified	Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services
217422	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs)	Form and Instruction	Modified	Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment

ICR Details

OMB Control No: 0938-1285	ICR Reference No: 202606-0938-010
Status: Received in OIRA	Previous ICR Reference No: 202208-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Data Submission for the Federally-facilitated Exchange User Fee Adjustment (CMS-10492)
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: 06/10/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	315	0
Time Burden (Hours)	1,340	0
Cost Burden (Dollars)	0	0

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Abstract: CMS will use the data collections from participating issuers and third party administrators to verify the total dollar amount for such payments for contraceptive services provided under this accommodation for the purpose of determining a participating issuer's user fee adjustment. The attestation that the payments for contraceptive services were made in compliance with 26 CFR 54.9815-2713A(b)(2) or 29 CFR 2590.715-2713A(b)(2) will help ensure that the user fee adjustment is being utilized to provide contraceptive services for the self-insured plans in accordance with the previously noted accommodation.

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Authorizing Statute(s): PL: Pub.L. 78 - 410 2713 Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 148 1321 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1311 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 2713 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 57199	12/10/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 32978	06/02/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)	CMS-10492	Notice of Availability of Separate Contraception Payments from Fully Insured Issuers
Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer)	CMS-10492, CMS-10492	Issuers' Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment ,   Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services
Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs)	CMS-10492, CMS-10492	Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment ,   Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services

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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	315	0	0	0	-10	325
Annual Time Burden (Hours)	1,340	0	0	0	-110	1,450
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: Based on the past years of experience with the collection of the contraceptive user fee adjustment data, we reduced the estimated number of participating issuers, from 40 to 30, which subsequently reduced the total number of burden hours (from 1,450 to 1,340). Wage rate estimates have also changed; therefore, costs per hour have been adjusted according to the most recently available BLS wage rates.

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Annual Cost to Federal Government: $96,232

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: 06/10/2026

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