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: 0938-1258	ICR Reference No: 202103-0938-016
Status: Historical Active	Previous ICR Reference No: 201802-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Disclosure of State Rating Requirements and Individual Market Special Enrollment Notice (CMS-10454)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/10/2021
	Date Received in OIRA: 03/18/2021
Terms of Clearance: Please update the burden estimate on the form when the expiration date is updated to be consistent with the burden calculation in this approval and submit the revised form as a non-substantive change.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2024	36 Months From Approved	08/31/2021
Responses	3	0	423
Time Burden (Hours)	17	0	2,338
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	3	423	-420
Annual Time Burden (Hours)	17	2,338	-2,321
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: Total burden for reporting decreased by 2,321 hours (from 2,338 hours to 17 hours) because states will only incur the burden of reporting changes to their rating factors.

Annual Cost to Federal Government: $242,632

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

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