Information Collection Requirements Contained in the State Flexibility to Stabilize the Market Grant Program (CMS-10657)

Forms and Documents

Document Name	Status
Form CMS-10657 State Flexibility Grants Activities Form and Instruction	New
CMS-10657 - Supporting Statement - 30-day.pdf Supporting Statement A	2019-04-01

IC Document Collections

IC ID	Document Title	Status
235550	State Flexibility Grants Activities Form and Instruction	New

ICR Details

OMB Control No: 0938-1366	ICR Reference No: 201904-0938-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 10657
Title: Information Collection Requirements Contained in the State Flexibility to Stabilize the Market Grant Program (CMS-10657)
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 without change	Conclusion Date: 07/11/2019
	Date Received in OIRA: 04/08/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2022	36 Months From Approved
Responses	155	0	0
Time Burden (Hours)	2,108	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The State Flexibility to Stabilize the Market Grant Program will provide a funding source to enhance and support the role of States in the implementation and planning for several of the Federal market reforms and consumer protections under Part A of Title XXVII of the Public Health Service Act (PHS Act). The purpose of the State Flexibility to Stabilize the Market Grant Program is to enhance the States’ ability to effectively regulate their respective private health insurance markets through innovative measures that support the pre-selected market reforms and consumer protections under Part A of Title XXVII of the PHS Act. States that are awarded funds under this funding opportunity are required to submit four quarterly progress reports, one annual report, and one final report at the end of the grant period, detailing a State’s progress in planning and/or implementation of the pre-selected market reforms and consumer protections under Part A of Title XXVII of the PHS Act. This information is required for effective oversight of State grantees’ use of federal funds.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 2794 Name of Law: Ensuring that consumers get value for their dollars
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 2794 Name of Law: Ensuring that consumers get value for their dollars

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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:
	83 FR 53474	10/23/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 9527	03/15/2019
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
State Flexibility Grants Activities	CMS-10657, CMS-10657, CMS-10657	State Flexibility Grant Annual Report Template ,   State Flexibility Grant Quarterly Report Template ,   State Flexibility Grant Final Report Template

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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	155	0	155	0	0	0
Annual Time Burden (Hours)	2,108	0	2,108	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: This is a new collection of information.

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Annual Cost to Federal Government: $275,488

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: 04/08/2019

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