Collection of Premium Credit Adjustment Data Related to COVID-19 Emergency (CMS-10751)

Forms and Documents

Document Name	Status
Form CMS-10751 Appendix A - Template for 2020 Premium Credits Form	New
CMS-10751 - Supporting Statement - OMB - Final.rtf Supporting Statement A	2020-08-25
CMS-10751- Premium Credit PRA Emergency Justification OMB.docx Supplementary Document	2020-08-07

IC Document Collections

IC ID	Document Title	Status
243085	Appendix A - Template for 2020 Premium Credits Form	New

ICR Details

OMB Control No: 0938-1381	ICR Reference No: 202008-0938-004
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Collection of Premium Credit Adjustment Data Related to COVID-19 Emergency (CMS-10751)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 08/28/2020
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/26/2020
	Date Received in OIRA: 08/25/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	6 Months From Approved
Responses	175	0	0
Time Burden (Hours)	175	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The implementing regulations for the Exchanges and QHP issuers, 45 CFR Parts 155 and 156, contain provisions that mandate reporting and data collections necessary to ensure that QHP issuers are meeting the requirements of the Affordable Care Act. CMS believes the one-time collection of data in this template necessitated by the COVID-19 emergency is supported by current agency requirements for enrollment reconciliation that are already included in these rules. Collection of this information allows CMS to comply with specific IRS regulations within the context of the flexibility we are offering QHP issuers in response to the COVID emergency. To ensure proper allocation of Advance Payments of the Premium Tax Credit (APTC) to the portion of premium that covers essential health benefits, CMS will adjust premium and APTC amounts in its enrollment data. CMS will also report to the IRS the premium and APTC changes in the issuer-submitted template for purposes of reconciliation to premium tax credits.

Emergency Justfication: The Centers for Medicare & Medicaid Services (CMS) is requesting that an information collection requirement associated with the Temporary Policy on 2020 Premium Credits Associated with the COVID-19 Public Health Emergency be processed in accordance with the implementing regulations of the Paperwork Reduction Act of 1995 at 5 CFR 1320.13(a)(2)(i). CMS will be unable to update CMS systems for IRS reporting purposes in time for tax season if the normal, non-emergency clearance procedures are followed. Specifically, we are requesting emergency approval for information collection requirements (ICRs) related to enrollment reconciliation (45 CFR 155.400(d) and 156.265(f)). In accordance with 5 CFR 1320.13(a)(2)(i), we believe that public harm is reasonably likely to ensue if the normal clearance procedures are followed. The use of normal clearance procedures will not allow CMS to update its enrollment data timely and is therefore is reasonably likely to prevent accurate and timely distribution of 1095-A tax forms to affected consumers. Health Insurance Exchanges furnish Form 1095-A to individuals to allow them to reconcile the credit on their returns with advance payments of the premium tax credit (APTC) and file an accurate tax return.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: US Code: 45 USC 156.80(d) Name of Law: Affordable Care Act

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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:
	85 FR 50027	08/17/2020
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
Appendix A - Template for 2020 Premium Credits	CMS-10751	Appendix A - Template for 2020 Premium Credits

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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	175	0	175	0	0	0
Annual Time Burden (Hours)	175	0	175	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: $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? Yes

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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: 08/25/2020

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