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OMB Control No: 0938-1193	ICR Reference No: 201908-0938-013
Status: Historical Active	Previous ICR Reference No: 201603-0938-019
Agency/Subagency: HHS/CMS	Agency Tracking No: 18758
Title: Data Collection to Support Eligibility Determinations and Enrollment for Small Businesses in the Small Business Health Options Program (CMS-10439)
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: 01/21/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/28/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2023	36 Months From Approved	01/31/2020
Responses	6,000	0	6,000
Time Burden (Hours)	960	0	12,000
Cost Burden (Dollars)	0	0	0

Abstract: On March 23, 2010, the President signed into law H.R. 3590, the Patient Protection and Affordable Care Act, Public Law 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. 111-152, collectively referred to as "The Affordable Care Act." The Affordable Care Act expands access to health insurance coverage through improvements to the Medicaid and Children's Health Insurance (CHIP) programs, the establishment of Affordable Insurance Exchanges (Exchanges), and the assurance of coordination between Medicaid, CHIP, and Exchanges. Through the Small Business Health Options Program (SHOP), the new Exchanges will assist qualified small employers in facilitating the enrollment of their employees in Qualified Health Plans (QHPs) offered in the small group market. The Exchanges, which will offer these QHPs, will become operational on January 1, 2014. Employers will be able to begin applying for coverage through the SHOP October 1, 2013, for coverage beginning as early as January 1, 2014. The employer's application for the SHOP will be a single, streamlined form that will be used to determine employer eligibility for the SHOP. The submission seeks OMB approval of the data collection elements needed to support eligibility determinations for small businesses in the SHOP.

Authorizing Statute(s): PL: Pub.L. 111 - 148 1311 Name of Law: Affordable Care Act

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:
	84 FR 30123	06/26/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 45154	08/28/2019
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
SHOP - Employer	CMS-10439	Appendix 1 SHOP Employer Questions

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	6,000	6,000	0
Annual Time Burden (Hours)	960	12,000	-11,040
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: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: Our burden estimates have changed since the last package and reflect a decreased burden for employers. Although the estimate of anticipated applicants has not changed since publication of the last package, the amount of information being collected from applicants has decreased substantially which has greatly decreased the burden on employer applicants. Applicants are now required to provide only basic identifying information (e.g., employer name, identification number, and contact information) on the SHOP Eligibility Determination Form as opposed to the more extensive information collected in the prior application, in which applicants also made enrollment selections and provided detailed information about their employees. The reduction of information being collected is a result of the Federally-facilitated Small Business Health Options Program (FF-SHOP) operating in a leaner fashion. Since publication of the last package, updates have been made in regulation concerning what information should be collected on the single employer application to determine employer eligibility, as reflected in 45 CFR § 155.731. We previously estimated we would receive 6,000 responses for a total burden estimate of 12,000 hours or $561,240. There are no changes to the number of respondents. However, the number of burden hours have been reduced from 12,000 hours to 960 hours, a total reduction of 11,040 hours. The reduction of information being collected from the applicant has resulted in the reduction of hours necessary to complete the application.

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]? 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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