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OMB Control No: 0938-1093	ICR Reference No: 202507-0938-005
Status: Received in OIRA	Previous ICR Reference No: 202204-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Disclosure and Recordkeeping Requirements for Grandfathered Health Plans under the Affordable Care Act (CMS-10325)
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	1,190	0
Time Burden (Hours)	40	0
Cost Burden (Dollars)	1,541	0

Abstract: Section 1251 of the ACA provides that certain plans and health insurance coverage in existence as of March 23, 2010, known as grandfathered health plans, are not required to comply with certain statutory provisions in the Act.To maintain its status as a grandfathered health plan, the interim final rule (75 FR 34538, June 17, 2010) require the plan to maintain records documenting the terms of the plan in effect on March 23, 2010, and any other documents that are necessary to verify, explain or clarify status as a grandfathered health plan.The plan must make such records available for examination upon request by participants,beneficiaries, individual policy subscribers, or a State or Federal agency official. A grandfathered health plan is also required to include a statement in any plan material provided to participants or beneficiaries describing the benefits provided under the plan or health insurance coverage, the plan or coverage believes it is a grandfathered health plan within the meaning of section 1251 of the ACA, that being a grandfathered health plan means that the plan does not include certain consumer protections of the ACA, and providing contact information for participants to direct questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status and to file complaints. The amendment to the interim final rule (75 FR 70114, November 17, 2010) requires a grandfathered group health plan that is changing health insurance issuers to provide the succeeding health insurance issuer (and the succeeding health insurance issuer must require) documentation of plan terms (including benefits, cost sharing, employer contributions, and annual limits) under the prior health insurance coverage sufficient to make a determination whether the standards of paragraph (g)(1) of the interim final regulations are exceeded.

Authorizing Statute(s): PL: Pub.L. 111 - 148 1251 Name of Law: Preservation of right to maintain existing coverage.

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:
	89 FR 103831	12/19/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 17601	04/28/2025
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Grandfathered Plan Change in Carrier Disclosure

ICR Summary of Burden

	Total Request	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,190	1,190
Annual Time Burden (Hours)	40	40
Annual Cost Burden (Dollars)	1,541	1,541

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:

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? No

Agency Contact: Jamaa Hill 301 492-4190

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