Patient Protection and Affordable Care Act Patient Protection Notice- Final Rule-(TD 9744)

Forms and Documents

Document Name	Status
2017-06-22 SS 1545-2181r.doc Supporting Statement A	2017-06-22

IC Document Collections

IC ID	Document Title	Status
193323	Patient Protection and Affordable Care Act Patient Protection Notice	Modified

ICR Details

OMB Control No: 1545-2181	ICR Reference No: 201705-1545-040
Status: Historical Active	Previous ICR Reference No: 201311-1545-019
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Patient Protection and Affordable Care Act Patient Protection Notice- Final Rule-(TD 9744)
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: 12/21/2017
	Date Received in OIRA: 07/17/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2020	36 Months From Approved	12/31/2017
Responses	693,007	0	4,000,000
Time Burden (Hours)	5,173	0	33,000
Cost Burden (Dollars)	5,371	0	0

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Abstract: The Patient Protection Notice is used by health plan sponsors and issuers to notify certain individuals of their right to (1) choose a primary care provider or a pediatrician when a plan or issuer requires participants or subscribers to designate a primary care physician; or (2) obtain obstetrical or gynecological care without prior authorization.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 2719A Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 152 1001 Name of Law: Health Care and Education Reconciliation 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:
	82 FR 19454	04/27/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 32602	07/14/2017
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
Patient Protection and Affordable Care Act Patient Protection Notice

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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	693,007	4,000,000	0	0	-3,306,993	0
Annual Time Burden (Hours)	5,173	33,000	0	0	-27,827	0
Annual Cost Burden (Dollars)	5,371	0	0	0	5,371	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: There were changes in the burden estimates due to the reduced number of impacted plans. Even though this information collection request may still impact plans in the future, the majority of the burden associated will have occurred during the initial three year approval, because this ICR only impacts plans that relinquish their grandfathered status during the first year that they do so. As time goes on, most of the plans that intend to relinquish their grandfathered status will already have done so. The reduced number of impacted plans will result in a total burden decrease of (27,827) annual burden hours and a decrease of (3,306,993) responses.

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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? 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: 07/17/2017

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