Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status

ICR Details

OMB Control No: 0938-1187	ICR Reference No: 202604-0938-001
Status: Received in OIRA	Previous ICR Reference No: 202204-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations (CMS-10433)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/07/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	1,053	0
Time Burden (Hours)	61,155	0
Cost Burden (Dollars)	0	0

---

Abstract: As required by the CMS-9989-F: Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers ("Exchange rule"), each Exchange must assume responsibilities related to the certification and offering of Qualified Health Plans ("QHP"). To offer insurance through an Exchange, a health insurance issuer must have its health plans certified as QHPs by the Exchange. A QHP must meet certain minimum certification standards, such as network adequacy, actuarial value standards, and the offering of the essential health benefits (EHB). The Exchange is responsible for ensuring that QHPs meet these minimum certification standards as described in the Exchange rule under 45 CFR 155 and 156, based on the Affordable Care Act, as well as other requirements determined by the Exchange.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 1343, 1401-1402 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1411-1412 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1301-1304, 1311-1312 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1321-1322 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1324, 1341 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 28753	07/01/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 14701	03/26/2026
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
QHP Certification	CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMs-10433, CMS-10433, CMS-10433, CMS-10433	Administrative Data Template ,   Plan Benefits Template ,   Network ID Template ,   Plans and Benefits Template ,   Prescriptions Drug Formulary Template ,   Rate Table Template ,   Service Area Template ,   Business Rules Template ,   QHP Certification Instrument Screenshots ,   Reinsurance Program and Risk Adjustment Program
Risk Adjustment	CMS-10433	Reinsurance and Risk Adjustment Bank Server
Stand-Alone Dental Issuers: QHP Certification
States: SBE's, Federal Platform and Partnership States	CMS-10433	Interoperability Web Form

---

ICR Summary of Burden

	Total Request	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	1,053	0	0	0	-1,872	2,925
Annual Time Burden (Hours)	61,155	0	0	0	-10,505	71,660
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: The number of stand-alone dental issuers for the QHP certification decreased from 270 to 212, which is a decrease of 58 issuers. The number of issuers in the individual and small group market decreased from 2,400 to 623, which is a decrease of 1,777 issuers. The number of both State-based Exchanges using the Federal Platform decreased from 22 to 3, which is a decrease of 19 states. The total burden hours decreased from 71,660 hours to 61,155 hours (-10,505.33 hours).

---

Annual Cost to Federal Government: $177,504

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? No

---

Common Form ICR:  No

---

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: 04/07/2026

---

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.