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OMB Control No:	ICR Reference No: 201311-0938-024
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 20980
Title: Coverage of Certain Preventive Services Under the Affordable Care Act
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 08/21/2014
	Date Received in OIRA: 11/19/2013
Terms of Clearance: CMS withdraws this collection to consolidate it with another submission.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

Abstract: Section 2713 of the Public Health Service Act requires coverage without cost sharing of certain preventive health services, including certain contraceptive services, in non-exempt, non-grandfathered group health plans and health insurance coverage. The final regulations "Coverage of Certain Preventive Services Under the Affordable Care Act" published by the Departments of Health and Human Services, the Treasury, and Labor, amend the authorization to exempt group health plans established or maintained by certain religious employers (and group health insurance coverage provided in connection with such plans) with respect to the requirement to cover contraceptive services. The final regulations also establish accommodations for group health plans established or maintained by certain additional religious organizations (and group health insurance coverage offered in connection with such plans), and for student health insurance coverage arranged by certain religious institutions of higher education. Each organization seeking accommodation under the proposed rules must self-certify that it meets the definition of eligible organization and provide a copy to a group health insurance coverage issuer. The proposed rules direct a health insurance issuer providing separate payments for contraceptive services at no additional cost to participants and beneficiaries in plans of eligible organizations to provide a written notice to plan participants and beneficiaries regarding the availability of the separate payment for contraceptive services.

Authorizing Statute(s): PL: Pub.L. 111 - 148 1001 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1563 Name of Law: Affordable Care Act
   US Code: 42 USC 300gg-13 Name of Law: Coverage of preventive health services

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1001 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1563 Name of Law: Affordable Care Act
US Code: 42 USC 300gg-13 Name of Law: Coverage of preventive health services

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AR42	Final or interim final rulemaking	78 FR 39870	07/02/2013

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Certification	CMS-10459
Notice	CMS-10459

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: This is a new information collection request.

Annual Cost to Federal Government: $0

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: Jamaa Hill 301 492-4190

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