View Information Collection Request (ICR) Package

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: 0938-1349	ICR Reference No: 201708-0938-021
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: State Permissions for Enrollment in Qualified Health Plans in the Federally Facilitated Exchange & Non-Exchange Entities (CMS-10650)
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: Approved with change	Conclusion Date: 02/21/2018
	Date Received in OIRA: 08/31/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved
Responses	104,165	0	0
Time Burden (Hours)	680,381	0	0
Cost Burden (Dollars)	0	0	0

Authorizing Statute(s): US Code: 45 USC 156 Name of Law: Health Insurance Issuer Standards under the Affordable Care Act
   PL: Pub.L. 111 - 156 1312 Name of Law: Patient Protection and Affordable Care Act
   US Code: 45 USC 144 Name of Law: Requirements Relating to Health Insurance Coverage
   US Code: 45 USC 147 Name of Law: Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets
   US Code: 45 USC 155 Name of Law: Exchange Establishment Standards and Other Related Standards under the Affordable Care Act

Citations for New Statutory Requirements: PL: Pub.L. 111 - 156 1312 Name of Law: Patient Protection and Affordable Care Act
US Code: 45 USC 144 Name of Law: Requirements Relating to Health Insurance Coverage
US Code: 45 USC 147 Name of Law: Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets
US Code: 45 USC 155 Name of Law: Exchange Establishment Standards and Other Related Standards under the Affordable Care Act
US Code: 45 USC 156 Name of Law: Health Insurance Issuer Standards under the Affordable Care Act

ICR Summary of Burden

	Total Approved	Change Due to New Statute
Annual Number of Responses	104,165	104,165
Annual Time Burden (Hours)	680,381	680,381
Annual Cost Burden (Dollars)	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: This is a new collection of information.

Annual Cost to Federal Government: $37,776

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. 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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