The Fiscal Soundness Reporting Requirements

Forms and Documents

Document Name	Status
Form CMS-906 The Fiscal Soundness Reporting Requirements (CMS-906) Form and Instruction	Modified
Supporting Statement - Part A_OMB 0938-0469-Final 08.08.19.docx Supporting Statement A	2019-08-08

IC Document Collections

IC ID	Document Title	Status
8094	The Fiscal Soundness Reporting Requirements (CMS-906) Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0469	ICR Reference No: 201904-0938-013
Status: Active	Previous ICR Reference No: 201602-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-906
Title: The Fiscal Soundness Reporting Requirements
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 with change	Conclusion Date: 08/14/2019
	Date Received in OIRA: 04/25/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2022	36 Months From Approved	10/31/2019
Responses	1,589	0	1,518
Time Burden (Hours)	530	0	506
Cost Burden (Dollars)	0	0	0

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Abstract: The information in this collection will be used by the financial review team in order to establish that the MAOs, PDPs, PACE Organizations, 1876 Cost Plans and Demonstration Plans are maintaining fiscally sound organizations.

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Authorizing Statute(s): Statute at Large: 18 Stat. 1857 Name of Statute: null
  

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:
	84 FR 731	01/31/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 15615	04/16/2019
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
The Fiscal Soundness Reporting Requirements (CMS-906)	CMS-906	Health Plan Management System (HPMS)

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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	1,589	1,518	0	71	0	0
Annual Time Burden (Hours)	530	506	0	24	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in burden from the previously filed PRA package is due to the increase in number of filings from contracting entities due to the following: • Growth in number of Medicare Advantage (MA) and Programs of All-Inclusive Care for the Elderly (PACE) contracting organizations. • Increase in number of MA and PACE contracting organizations needing to report annually and quarterly.

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Annual Cost to Federal Government: $41,981

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]? No

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: 04/25/2019

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