View Information Collection Request (ICR) Package

OMB Control No: 0985-0040	ICR Reference No: 202009-0985-002
Status: Historical Active	Previous ICR Reference No: 201808-0985-002
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: State Health Insurance Assistance Program (SHIP) Client Contact Forms
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: 12/30/2020
	Date Received in OIRA: 10/01/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2023	36 Months From Approved	12/31/2020
Responses	3,981,613	0	3,722,025
Time Burden (Hours)	329,244	0	215,288
Cost Burden (Dollars)	0	0	0

Abstract: The purpose of this data collection is to collect performance data from grantees, grantee team members and partners. Congress requires this data collection for program monitoring and Government Performance Results Act (GPRA) purposes. This data collection allows ACL and the Center for Innovation and Partnership (CIP) to communicate with Congress and the public on the SHIP, the SMP program, the Medicare Improvements for Patients & Providers Act (MIPPA) program, and the ADRC activities. In addition to the SHIP Data Performance Reports and Information Collection under OMB 0985-0040, ACL requests to incorporate the discontinued SMP Report collection OMB 0985-0024 and the ADRC collection OMB 0985-0062 into one tool. The SHIP, SMP, MIPPA, and ADRC programs are located in each of the 50 states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. In order to ensure that grantees report activity accurately and consistently it is imperative that these data collection tools remain active. The respondents for this data collection are grantees, grantee team members, and partners who meet with Medicare beneficiaries and older adults in group settings and in one-on-one sessions to educate them on Medicare enrollment, Medicare benefits and subsidy programs, the importance of being aware of Medicare fraud, error and abuse, and having the knowledge to protect the Medicare system. ACL is proposing to combine these four collection tools to reduce burden on the grantees, grantee team members, and partners as many of the individuals working on these programs, collecting information, and reporting results are the same at the local level. Combining these tools will reduce the need for duplicate or triplicate reporting of activities in separate tools further reducing the time and effort in reporting outcomes and activities. In addition, this combination will allow clarification on when, where, and how activities are being conducted across these ACL programs further informing performance outcomes.

Authorizing Statute(s): US Code: 42 USC 1395b-4 Name of Law: Health insurance information, counseling, and assistance grants
PL: Pub.L. 101 - 508 4360(F) Name of Law: Health Insurance Information, Counseling, and Assistance Grants

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 71954	12/30/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 60805	09/28/2020
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	3,981,613	3,722,025	259,588
Annual Time Burden (Hours)	329,244	215,288	113,956
Annual Cost Burden (Dollars)	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: This is a revision request; ACL has modified several forms and combined several data elements due to the inclusion of the MIPPA and SMP programs. The addition of these programs have increased the previous time burden for this particular IC tool, however this combination has reduced the overall burden on respondents by reducing the need to track and report similar activities in separate systems eliminating the duplication action of accessing multiple systems. Taking into account previous collection year burden totals that have updated, there is a program change of 113,956 annual burden hours.

Annual Cost to Federal Government: $40,048

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? No

Agency Contact: Tomakie Washington 202 795-7336 tomakie.washington@acl.hhs.gov

View ICR - OIRA Conclusion