View Information Collection Request (ICR) Package
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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:
0938-1271
ICR Reference No:
201806-0938-003
Status:
Historical Active
Previous ICR Reference No:
201502-0938-009
Agency/Subagency:
HHS/CMS
Agency Tracking No:
CMS-10544
Title:
Good Cause Processes (CMS-10544)
Type of Information Collection:
Reinstatement without change of a previously approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
12/03/2018
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/14/2018
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2021
36 Months From Approved
Responses
10,008
0
0
Time Burden (Hours)
6,665
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
Beneficiaries are provided a protection outlined in regulation at 42 CFR 417.460, 422.74, and 423.44 that provides CMS with the ability to reinstate an individual's enrollment into a Medicare Advantage, Part D or cost plan in certain circumstances where the individual's non-payment of plan premiums was due to circumstances that the individual could not reasonably foresee or could not control, such as an unexpected hospitalization. This submission calculates the administrative cost by Medicare Advantage, Part D and cost plans to process such requests on behalf of CMS.
Authorizing Statute(s):
US Code:
18 USC 1851(g)(3)(B)(i)
Name of Law: Social Security Act (Part C)
US Code:
18 USC 1860D-1(b)(1)(B)
Name of Law: Social Security Act (Part D)
US Code:
18 USC 1876(c)(3)(B)
Name of Law: Social Security Act (Payments to Health Maintenance Organizations and Competitive Medical 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:
83 FR 10730
03/12/2018
30-day Notice:
Federal Register Citation:
Citation Date:
83 FR 26691
06/08/2018
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Good Cause Processes (Sec. 417.460, 422.74, and 423.44)
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
10,008
0
0
1,632
0
8,376
Annual Time Burden (Hours)
6,665
0
0
2,477
0
4,188
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:
No
Burden Reduction Due to:
Short Statement:
The higher costs are also the result of the increased number of plans that are dis-enrolling members for nonpayment of premiums and the number of beneficiaries dis-enrolled under these policies. Further, the cost associated with the beneficiary completing the request was also factored into the burden for 2017, whereas in 2015 this cost was not factored into the estimate.
Annual Cost to Federal Government:
$0
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]?
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:
Kayla Williams 410 786-5887 Kayla.Williams@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:
06/14/2018
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