Grants to States for Consumer Assistance Program

Forms and Documents

Document Name	Status
Form CMS-10333 Data Collection Report (1st and 2nd Quarterly Submissions) Form and Instruction	Modified
Form CMS-10333 Data Collection Report (Initial Submission) Form and Instruction	Modified
Form CMS-10333 Application Burden Form and Instruction	Removed
Response CAP PRA comments7 811.docx Supplementary Document	2011-07-29
CMS-10333.Supporting Statement Part A.doc Supporting Statement A	2011-07-29

IC Document Collections

IC ID	Document Title	Status
193768	Data Collection Report (1st and 2nd Quarterly Submissions) Form and Instruction	Modified
193767	Data Collection Report (Initial Submission) Form and Instruction	Modified
193766	Application Burden Form and Instruction	Removed

ICR Details

OMB Control No: 0938-1097	ICR Reference No: 201107-0938-017
Status: Historical Active	Previous ICR Reference No: 201101-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Grants to States for Consumer Assistance Program
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: 09/29/2011
	Date Received in OIRA: 07/29/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2014	36 Months From Approved	09/30/2011
Responses	120	0	204
Time Burden (Hours)	4,800	0	9,690
Cost Burden (Dollars)	190,000	0	242,250

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Abstract: Pursuant to section 2793(d) of the Public Health Services Act (PHSA), as amended by Section 1002 of the Affordable Care Act (ACA), as a condition for receiving the consumer assistance program grant, programs must collect and report data to the Secretary on the types of problems and inquiries encountered by consumers. Accordingly, program staff will need a system to maintain case files that will track these types of problems and inquiries. Problems and inquiries will be summarized and will be reported to HHS. By law, the user of the summary data is the Secretary of HHS and will be used for oversight. Further, ACA dictates that the Secretary will share these reports with the Department of Labor and Treasury, and with State insurance regulators for use in enforcement.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1002 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 21371	04/15/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 45575	07/29/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Data Collection Report (Initial Submission)	CMS-10333	Screenshot
Data Collection Report (1st and 2nd Quarterly Submissions)	CMS-10333	Screenshots
Application Burden	CMS-10333	CMS-10333.Deliberative Document

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	120	204	0	-51	-33	0
Annual Time Burden (Hours)	4,800	9,690	0	0	-4,890	0
Annual Cost Burden (Dollars)	190,000	242,250	0	0	-52,250	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:

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Annual Cost to Federal Government: $30,884

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

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Common Form ICR:  No

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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: 07/29/2011

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