View Information Collection Request (ICR) Package
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Brief and OIRA conclusion
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Burden
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Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
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:
0938-1119
ICR Reference No:
201504-0938-011
Status:
Historical Active
Previous ICR Reference No:
201411-0938-005
Agency/Subagency:
HHS/CMS
Agency Tracking No:
20357
Title:
Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges (CMS-10371)
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:
05/27/2015
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/24/2015
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2018
36 Months From Approved
05/31/2015
Responses
1,080
0
860
Time Burden (Hours)
30,731
0
64,140
Cost Burden (Dollars)
0
0
28,081
Abstract:
Information collected as a part of the application for this grant will be used to evaluate the applications and determine awardees. Information collected pursuant to the reporting requirements for awardees will be used to evaluate the progress of States in planning for and implementing Exchanges, and determine how the Secretary can provide assistance to achieve the goals of the grant program and the Affordable Care Act.
Authorizing Statute(s):
PL:
Pub.L. 111 - 148 1311
Name of Law: Affordable choices of health benefit plans
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:
80 FR 5118
01/30/2015
30-day Notice:
Federal Register Citation:
Citation Date:
80 FR 21721
04/20/2015
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
9
IC Title
Form No.
Form Name
Annual Report
CMS-10371, CMS-10371
Annual Report Template
,
Annual Reporting Data Elements
Application
CMS-10371
Revised FOA
Budget Report
CMS-10371
Budget Report
Implementation Review
CMS-10371
Exchange Establishment Grant FOA
Monthly Reports
CMS-10371, CMS-10371
Monthly Progress Report
,
Monthly Progress Report Data Elements
Performance Reviews
CMS-10371
Revised FOA
,
Revised FOA
Periodic Reporting
CMS-10371
Revised FOA
Public - Progress Reports
CMS-10371, CMs-10371
Progress Report
,
Progress Report
Quarterly Reports
CMS-10371
Quarterly Template
Semi-Annual Reports
CMS-10371
Establishment Review - Semi-Annual
Start-Up Year Establishment Review
Weekly Reports
CMS-10371
Weekly Report
Work Plan Update
CMS-10371
Establishment Review - Work Plan Update
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
1,080
860
0
0
220
0
Annual Time Burden (Hours)
30,731
64,140
0
0
-33,409
0
Annual Cost Burden (Dollars)
0
28,081
0
0
-28,081
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:
This ICR revision deletes the requirements for the application as there are no further funds being awarded under this program. It also deletes separate planning and design reviews, and creates a single multi-faceted Implementation Review that encompasses examination of the design, implementation and effectiveness of each Marketplace's infrastructure and processes required for effective performance. As a result, there is a total reduction of 33,409 burden hours.
Annual Cost to Federal Government:
$394,912
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
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:
04/24/2015
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