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OMB Control No: 0938-1381	ICR Reference No: 202008-0938-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Collection of Premium Credit Adjustment Data Related to COVID-19 Emergency (CMS-10751)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 08/28/2020
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/26/2020
	Date Received in OIRA: 08/25/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	6 Months From Approved
Responses	175	0	0
Time Burden (Hours)	175	0	0
Cost Burden (Dollars)	0	0	0

Abstract: The implementing regulations for the Exchanges and QHP issuers, 45 CFR Parts 155 and 156, contain provisions that mandate reporting and data collections necessary to ensure that QHP issuers are meeting the requirements of the Affordable Care Act. CMS believes the one-time collection of data in this template necessitated by the COVID-19 emergency is supported by current agency requirements for enrollment reconciliation that are already included in these rules. Collection of this information allows CMS to comply with specific IRS regulations within the context of the flexibility we are offering QHP issuers in response to the COVID emergency. To ensure proper allocation of Advance Payments of the Premium Tax Credit (APTC) to the portion of premium that covers essential health benefits, CMS will adjust premium and APTC amounts in its enrollment data. CMS will also report to the IRS the premium and APTC changes in the issuer-submitted template for purposes of reconciliation to premium tax credits.

Emergency Justfication: The Centers for Medicare & Medicaid Services (CMS) is requesting that an information collection requirement associated with the Temporary Policy on 2020 Premium Credits Associated with the COVID-19 Public Health Emergency be processed in accordance with the implementing regulations of the Paperwork Reduction Act of 1995 at 5 CFR 1320.13(a)(2)(i). CMS will be unable to update CMS systems for IRS reporting purposes in time for tax season if the normal, non-emergency clearance procedures are followed. Specifically, we are requesting emergency approval for information collection requirements (ICRs) related to enrollment reconciliation (45 CFR 155.400(d) and 156.265(f)). In accordance with 5 CFR 1320.13(a)(2)(i), we believe that public harm is reasonably likely to ensue if the normal clearance procedures are followed. The use of normal clearance procedures will not allow CMS to update its enrollment data timely and is therefore is reasonably likely to prevent accurate and timely distribution of 1095-A tax forms to affected consumers. Health Insurance Exchanges furnish Form 1095-A to individuals to allow them to reconcile the credit on their returns with advance payments of the premium tax credit (APTC) and file an accurate tax return.

Authorizing Statute(s): None

Citations for New Statutory Requirements: US Code: 45 USC 156.80(d) Name of Law: Affordable Care Act

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:
	85 FR 50027	08/17/2020
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
Appendix A - Template for 2020 Premium Credits	CMS-10751

ICR Summary of Burden

	Total Approved	Change Due to New Statute
Annual Number of Responses	175	175
Annual Time Burden (Hours)	175	175
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: $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? Yes

Agency Contact: Jamaa Hill 301 492-4190

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