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OMB Control No: 0938-0841	ICR Reference No: 201401-0938-014
Status: Historical Active	Previous ICR Reference No: 201010-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: 21337
Title: State Children's Health Insurance Program and Supporting Regulations in 42 CFR 431.636, 457.50, 457.60, 457.70, 457.340, 457.350, 457.431, 457.440, 457.525, 457.560,...
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: 03/12/2014
	Date Received in OIRA: 01/29/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved	03/31/2014
Responses	28,294,596	0	1,114,124
Time Burden (Hours)	1,473,855	0	864,973
Cost Burden (Dollars)	0	0	0

Abstract: States are required to submit title XXI plans and amendments for approval by the Secretary pursuant to section 2102 of the Social Security Act in order to receive funds for initiating and expanding health insurance coverage for uninsured children. States are also required to submit State expenditure and statistical reports, annual reports and State evaluations to the Secretary as outlined in the XXI of the Social Security Act.

Authorizing Statute(s): Statute at Large: 21 Stat. 2101
   Statute at Large: 21 Stat. 2102
   Statute at Large: 21 Stat. 2106
   Statute at Large: 21 Stat. 2107

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:
	78 FR 61848	10/04/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 3818	01/23/2014
Did the Agency receive public comments on this ICR? Yes

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	28,294,596	1,114,124	27,180,472
Annual Time Burden (Hours)	1,473,855	864,973	608,882
Annual Cost Burden (Dollars)	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: While there were no program changes, there are a number of adjustments to our burden estimates that were made based on using more current data and correcting miscalculations. More specifically: Section 457.340: Revised the number of states with a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). Section 457.350: Revised the number of states with a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). Noted that the previous calculation is incorrect - $23.63 per hour X 218,300 hours = $5,158,429. Section 457.525: The 2011 calculation was incorrect. If following the formula, then the hourly rate is multiplied by the total number of hours: $23.63 x 118,040 = $2,7879,285. Section 457.570: Revised the number of states with a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). Section 457.940: Revised the number of states with a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). Section 457.945: Revised the number of states with a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). Section 457.985: Revised the number of states with a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). Section 457.1180: Revised the number of CHIP enrollees in a separate CHIP program based on FY2012 CHIP enrollment data. Due to the increase in the number of states, calculations have been computed using current FY2012 data (43 vs 37 respondents). In addition to the adjustments noted above, this package also corrects the number of responses and the total hour burden that was set out in the 2011 PRA package (approved January 10, 2011). In that regard, this package adds a burden table under section 12 of this Supporting Statement to help clarify the 2014 burden estimates and calculations.

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]? No

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: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov

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