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: 0938-1312	ICR Reference No: 202009-0938-016
Status: Historical Active	Previous ICR Reference No: 201603-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Establishment of an Exchange by a State and Qualified Health Plans (CMS-10593)
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 with change	Conclusion Date: 07/27/2021
	Date Received in OIRA: 10/13/2020
Terms of Clearance: In the next submission please develop a burden estimate for 45 CFR Sec. 155.405(b) based on the number of Exchanges using an alternative application in accordance with 5 CFR Sec. 1320.3(c)(4)(i).

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2024	36 Months From Approved
Responses	132	0	0
Time Burden (Hours)	55,026	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	132	-277	409
Annual Time Burden (Hours)	55,026	-1,431	56,457
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: No

Burden Reduction Due to:

Short Statement: OMB previously approved this information collection in August 2016, with a total of 56,457 burden hours. This revision removes burden estimates for activities that are now The Quality Rating System requirement for SBEs to display QRS data on the SBE website were added to this collection, for which all SBEs are responsible. We estimate that 20 SBEs will take approximately 33 hours annually for the time and effort to display the QRS data they will already be collecting, for a total of 660 hours. Additionally, this revision removes burden estimates for activities that are now covered by other ICRs and certain SHOP provisions that are no longer requirements of Exchanges. As a result, the total burden hours have been reduced to from 56,457 to 51,485.

Annual Cost to Federal Government: $358,973

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? No

Agency Contact: Jamaa Hill 301 492-4190

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.