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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:
0938-1065
ICR Reference No:
201411-0938-011
Status:
Historical Active
Previous ICR Reference No:
201111-0938-006
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
CHIPRA 2009, Dental Provider and Benefit Information Posted on Insure Kids Now! Website (CMS-10291)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
02/03/2015
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/03/2014
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2018
36 Months From Approved
02/28/2015
Responses
255
0
255
Time Burden (Hours)
10,838
0
9,690
Cost Burden (Dollars)
0
0
0
Abstract:
Secretary shall work with States, pediatric dentists, and other dental providers to include on the Insure Kids Now (IKN) website (http://www.insurekidsnow.gov/) and hotline (1-877-KIDS-NOW), a current and accurate list of all such dentists and providers within each State that provide dental services to children enrolled in the State plan (or waiver) under Medicaid or the State child health plan (or waiver) under CHIP. Section 501 also requires the Secretary shall ensure that such a list is updated at least quarterly and includes a description of the dental services provided under Medicaid or CHIP, whether the services are provided through a state plan or a waiver. The Secretary shall also post on the IKN website State specific information on available dental benefits. CMS works closely with the Health Resources Services Administration (HRSA), which administers the IKN website, to implement this provision of CHIPRA. The collection commenced in 2009.
Authorizing Statute(s):
PL:
Pub.L. 111 - 3 501
Name of Law: Children's Health Insurance Program Reauthorization Act of 2009
Citations for New Statutory Requirements:
PL: Pub.L. 111 - 3 501 Name of Law: Children's Health Insurance Program Reauthorization Act of 2009
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:
79 FR 54725
09/12/2014
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 69480
11/21/2014
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
Collection of Dental Benefit Information
CMS-10291, CMS-10291
Insure Kids Now Children’s Dental Benefits Survey
,
Description of Dental Benefits Provided Under Medicaid and CHIP
Collection of Dental Provider Information
CMS-10291
Provider Data Submission Technical Information
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
255
255
0
0
0
0
Annual Time Burden (Hours)
10,838
9,690
0
1,148
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Changing Forms
Short Statement:
***Dental Provider Data Collection*** Concerning the dental provider data collection, we estimated a total increased burden to states of 36 hours per year (9 hours per quarter) to populate the five new fields in the provider record, to populate the Program Name field which is no longer optional, and to interface with the Program Name/Plan Name validation function, including correcting any errors. We also estimated a one-time increased burden of 0.5 hours to place column headers on all fields and a one-time increased burden of 0.5 hours to reconfigure the IKN Client Tool (only for states that have an out-dated version of the Tool). This is a total increased burden of 37 hours per year from these changes. We also estimated a reduction in burden of 2.25 hours per quarter (or 9 hours annually) due to new features that assist with efficiently managing data and accounts. The net increased burden to states for the dental provider data collection is 28 hours annually (7 hours per quarter) or 1,428 hours (aggregate). The adjusted burden is 9,588 hr (8,160 hr in 2011 + 1,428 hr in 2014). ***Dental Benefit Information Data Collection*** Concerning the dental benefit information data collection, we estimated a 5.5 hour reduction (-280.5 hr aggregate) in the annual burden due to the new electronic forms and submission. The adjusted burden is 1,249.5 hr (1,530 hr in 2011 - 280.5 hr in 2014).
Annual Cost to Federal Government:
$431,000
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
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
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:
12/03/2014
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