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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-1087
ICR Reference No:
201202-0938-004
Status:
Historical Active
Previous ICR Reference No:
201106-0938-023
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Early Retiree Reinsurance Program
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
03/23/2012
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/14/2012
Terms of Clearance:
OMB notes compliance with the previous terms of clearance.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2014
09/30/2014
09/30/2014
Responses
14,086
0
18,872
Time Burden (Hours)
283,211
0
579,704
Cost Burden (Dollars)
0
0
0
Abstract:
This information collection request covers the recordkeeping and reporting requirements associated with the Early Retiree Reinsurance Program.
Authorizing Statute(s):
PL:
Pub.L. 111 - 148 1102
Name of Law: Patient Protection and Affordable Care Act
US Code:
42 USC 18002
Name of Law: Reinsurance for Early Retirees
Citations for New Statutory Requirements:
None
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:
75 FR 80817
12/23/2010
30-day Notice:
Federal Register Citation:
Citation Date:
76 FR 37813
06/28/2011
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
9
IC Title
Form No.
Form Name
(149.335) - Documentation of Actual Medical Claims Involved
CMS-10321
ERRP Prima Facie Evidence Cover Sheet
(149.35(b)(2)) - Written Agreement with Issuer or Plan
(149.35(b)(3)) - Procedures to Protect Against Fraud, etc.
(149.350) Maintenance of Records
(149.40) - Updating Data in the Application
CMS-10321
ERRP Application
(149.500 & 149.510) - Requesting Appeals
(149.600) - Reporting Previous Data Inaccuracies
(149.610) - Requesting Reopenings
(149.700) - Reporting Change of Ownership
Early Retiree Reinsurance Program Appeals (Private), for Program Year 4
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Appeals (Private), for Program Years 2 and 3
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Appeals (Public), for Program Year 4
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Appeals (Public), for Program Years 2 and 3
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Reopening Requests (Private), for Program Years 2, 3, 4
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Reopening Requests (Pub lic), for Program Years 2, 3, 4
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Private) Program Year 2
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Private) Program Year 3
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Private) Program Year 4
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Public) Program Year 2
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Public) Program Year 3
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Public) Program Year 4
CMS-10321
Revised ERRP Collection Instrument
Private Application Update Year 2_3_4
CMS-10321
Revised ERRP Collection Instrument
Private CHOW Years 2_3_4
CMS-10321
Revised ERRP Collection Instrument
Private Data Inaccuracies Years 2_3_4
CMS-10321
ERRP Collection Instrument
Private Fraud and Abuse Procedures Years 2_3_4
CMS-10321
Revised ERRP Collection Instrument
Private Maintenance of Records Year 2_3_4
Private Written Agreement Year 2_3_4
CMS-10321
Revised ERRP Collection Instrument
Public Application Update Year 2_3_4
CMS-10321
Revised ERRP Collection Instrument
Public CHOW Years 2_3_4
CMS-10321
ERRP Collection Instrument
Public Data Inaccuracies Years 2_3_4
CMS-10321
Revised ERRP Collection Instrument
Public Fraud and Abuse Procedures Years 2_3_4
CMS-10321
Revised ERRP Collection Instrument
Public Maintenance of Records Year 2_3_4
CMS-10321
Revised ERRP Collection Instrument
Public Written Agreement Year 2_3_4
CMS-10321
Revised ERRP Collection Instrument
ICR Summary of Burden
Total Approved
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
14,086
18,872
0
-18,872
14,086
0
Annual Time Burden (Hours)
283,211
579,704
0
-579,704
283,211
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
This revision makes technical changes to the approved ICR to clarify the various information collections associated with this approval. The agency also took the opportunity to update the respondent and burden hour estimates based on most recent experience.
Annual Cost to Federal Government:
$30,000,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
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?
Uncollected
Agency Contact:
William Parham 4107864669
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:
02/08/2012
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