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OMB Control No: 0938-1157	ICR Reference No: 202507-0938-004
Status: Received in OIRA	Previous ICR Reference No: 202204-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Student Health Insurance Coverage (CMS-10377)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 07/15/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	913,790	0
Time Burden (Hours)	46	0
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	913,790	-39,730	953,520
Annual Time Burden (Hours)	46	-2	48
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: The burden hours for the AV and metal level disclosure have decreased by 2 hours (from 48 to 46) due to the decrease in the estimated number of issuers offering student health coverage (from 48 to 46).

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