View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
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:
0938-1285
ICR Reference No:
202302-0938-001
Status:
Historical Inactive
Previous ICR Reference No:
202208-0938-009
Agency/Subagency:
HHS/CMS
Agency Tracking No:
CCIIO
Title:
Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment (CMS-10492)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Comment filed on proposed rule and continue
Conclusion Date:
04/03/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/02/2023
Terms of Clearance:
In accordance with 5 CFR 1320, the information collection is not approved at this time. Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2025
36 Months From Approved
09/30/2025
Responses
325
0
325
Time Burden (Hours)
1,450
0
1,450
Cost Burden (Dollars)
0
0
0
Abstract:
CMS will use the data collections from participating issuers and third party administrators to verify the total dollar amount for such payments for contraceptive services provided under this accommodation for the purpose of determining a participating issuer's user fee adjustment. The attestation that the payments for contraceptive services were made in compliance with 26 CFR 54.9815-2713A(b)(2) or 29 CFR 2590.715-2713A(b)(2) will help ensure that the user fee adjustment is being utilized to provide contraceptive services for the self-insured plans in accordance with the previously noted accommodation.
Authorizing Statute(s):
PL:
Pub.L. 111 - 148 2713
Name of Law: Patient Protection and Affordable Care Act
Citations for New Statutory Requirements:
PL: Pub.L. 111 - 148 2713 Name of Law: Affordable Care Act
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AU94
Proposed rulemaking
88 FR 7236
02/02/2023
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
5
IC Title
Form No.
Form Name
Collection of User Fee Adjustment Information from FFE (or SBE-FP) Participating Issuers
Data Submission and Maintenance of Records for Individual Contraceptive Arrangement
Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)
CMS-10492
Notice of Availability of Separate Contraception Payments from Fully Insured Issuers
Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer)
CMS-10492, CMS-10492
Issuers' Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment
,
Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services
Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs)
CMS-10492, CMS-10492
Issuers Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment
,
Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services
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:
Burden hours increased as a result of 2023 rulemaking which proposes to allow an eligible individual to voluntarily, and independently of any actions by the objecting entity, elect an individual contraceptive arrangement. In addition, participating providers of contraceptive services would be required, as a condition of participation in the proposed individual contraceptive arrangement, to maintain documentation for 10 years. Therefore, burden has been adjusted accordingly from 1,450 hours to 380,850 hours, a total of 379,400 hours.
Annual Cost to Federal Government:
$9,187
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
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
02/02/2023
An official website of the United States government
The .gov means it's official.
The site is secure.
