Cost-Sharing Reduction Reconciliation (CMS-10526)

Forms and Documents

Document Name	Status
Form CMS-10526 Simplified Methodology Effective Parameters and Plan and Policy Reports Form and Instruction	Modified
Form CMS-10526 Standard Methodology Plan and Policy Report Form and Instruction	Modified
Form CMS-10526 Simplified Actuarial Value Methodology Plan and Policy Report Form and Instruction	Modified
Form CMS-10526 Issuer Report Form and Instruction	Modified
CMS-10526 - Supporting Statement CSR.docx Supporting Statement A	2016-02-01
CMS-10526 Response_to_Public_Comments (01 12 16).doc Supplementary Document	2016-02-01
CMS 10526 30 day crosswalk 01 12 2016.pdf Supplementary Document	2016-02-01

IC Document Collections

IC ID	Document Title	Status
213320	Simplified Methodology Effective Parameters and Plan and Policy Reports Form and Instruction	Modified
213319	Standard Methodology Plan and Policy Report Form and Instruction	Modified
213296	Simplified Actuarial Value Methodology Plan and Policy Report Form and Instruction	Modified
213295	Issuer Report Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1266	ICR Reference No: 201601-0938-004
Status: Historical Active	Previous ICR Reference No: 201409-0938-016
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Cost-Sharing Reduction Reconciliation (CMS-10526)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/11/2016
	Date Received in OIRA: 02/01/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2019	36 Months From Approved	12/31/2017
Responses	4,000,323	0	4,000,323
Time Burden (Hours)	6,757	0	6,757
Cost Burden (Dollars)	0	0	0

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Abstract: This collection is necessary for HHS to reconcile advance payments for cost-sharing reductions to health insurance issuers against actual amounts paid by issuers on behalf of enrollees during the benefit year.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1402 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1412 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:
	80 FR 55117	09/14/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 3146	01/20/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Simplified Actuarial Value Methodology Plan and Policy Report	CMS-10526	CSR Reconciliation Data Elements
Standard Methodology Plan and Policy Report	CMS-10526	CSR Reconciliation Data Elements
Simplified Methodology Effective Parameters and Plan and Policy Reports	CMS-10526	CSR Reconciliation Data Elements
Issuer Report	CMS-10526	CSR Reconciliation Data Elements

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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	4,000,323	4,000,323	0	0	0	0
Annual Time Burden (Hours)	6,757	6,757	0	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:

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Annual Cost to Federal Government: $14,552

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: 02/01/2016

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