Student Health Insurance Coverage

Forms and Documents

Document Name	Status
CMS-10377 SHC Supporting Statement 12-4-13.docx Supporting Statement A	2014-01-27

IC Document Collections

IC ID	Document Title	Status
200070	Student Health Insurance Notice Requirement Other-Notice	Modified

ICR Details

OMB Control No: 0938-1157	ICR Reference No: 201309-0938-027
Status: Historical Active	Previous ICR Reference No: 201111-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: 20603
Title: Student Health Insurance Coverage
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/27/2014
	Date Received in OIRA: 09/26/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2017	36 Months From Approved
Responses	2,250,010	0	0
Time Burden (Hours)	74,925	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Under the Student Health Insurance Final Rule, issuers of student health insurance are required to disclose to the student and any dependents in the insurance policy or certificate and any other written materials that the policy being issued does not meet all of the requirements under the Affordable Care Act.

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Authorizing Statute(s): US Code: 42 USC 18118(c) Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: US Code: 42 USC 18118(c) Name of Law: Public Health Service Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AQ95	Final or interim final rulemaking	77 FR 16453	03/21/2013

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Student Health Insurance Notice Requirement

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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	2,250,010	0	2,250,010	0	0	0
Annual Time Burden (Hours)	74,925	0	74,925	0	0	0
Annual Cost Burden (Dollars)	0	0	0	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 is a new information collection.

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Annual Cost to Federal Government: $0

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: 09/26/2013

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