Agency Information Collection Activities: Submission for OMB Review; Comment Request, 16184-16186 [2016-06830]
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16184
Federal Register / Vol. 81, No. 58 / Friday, March 25, 2016 / Notices
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10316]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Centers for Medicare &
Medicaid Services.
ACTION: Notice.
AGENCY:
The Centers for Medicare &
Medicaid Services (CMS) is announcing
an opportunity for the public to
comment on CMS’ intention to collect
information from the public. Under the
Paperwork Reduction Act of 1995 (the
PRA), federal agencies are require; to
publish notice in the Federal Register
concerning each proposed collection of
information (including each proposed
extension or reinstatement of an existing
collection of information) and to allow
60 days for public comment on the
proposed action. Interested persons are
invited to send comments regarding our
burden estimates or any other aspect of
this collection of information, including
any of the following subjects: (1) The
necessity and utility of the proposed
information collection for the proper
performance of the agency’s functions;
(2) the accuracy of the estimated
burden; (3) ways to enhance the quality,
utility, and clarity of the information to
be collected; and (4) the use of
automated collection techniques or
other forms of information technology to
minimize the information collection
burden.
DATES: Comments must be received by
May 24, 2016.
ADDRESSES: When commenting, please
reference the document identifier or
OMB control number. To be assured
consideration, comments and
recommendations must be submitted in
any one of the following ways:
1. Electronically. You may send your
comments electronically to https://
www.regulations.gov. Follow the
instructions for ‘‘Comment or
Submission’’ or ‘‘More Search Options’’
to find the information collection
document(s) that are accepting
comments.
2. By regular mail. You may mail
written comments to the following
address: CMS, Office of Strategic
Operations and Regulatory Affairs,
Division of Regulations Development,
Attention: Document Identifier/OMB
Control Number llll, Room C4–26–
05, 7500 Security Boulevard, Baltimore,
Maryland 21244–1850.
asabaliauskas on DSK3SPTVN1PROD with NOTICES
SUMMARY:
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To obtain copies of a supporting
statement and any related forms for the
proposed collection(s) summarized in
this notice, you may make your request
using one of following:
1. Access CMS’ Web site address at
https://www.cms.hhs.gov/Paperwork
ReductionActof1995.
2. Email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov.
3. Call the Reports Clearance Office at
(410) 786–1326.
FOR FURTHER INFORMATION CONTACT:
Reports Clearance Office at (410) 786–
1326.
SUPPLEMENTARY INFORMATION:
Contents
This notice sets out a summary of the
use and burden associated with the
following information collections. More
detailed information can be found in
each collection’s supporting statement
and associated materials (see
ADDRESSES).
CMS–10316 Implementation of the
Medicare Prescription Drug Plan (PDP)
and Medicare Advantage (MA) Plan
Disenrollment Reasons Survey
Under the PRA (44 U.S.C. 3501–
3520), federal agencies must obtain
approval from the Office of Management
and Budget (OMB) for each collection of
information they conduct or sponsor.
The term ‘‘collection of information’’ is
defined in 44 U.S.C. 3502(3) and 5 CFR
1320.3(c) and includes agency requests
or requirements that members of the
public submit reports, keep records, or
provide information to a third party.
Section 3506(c)(2)(A) of the PRA
requires federal agencies to publish a
60-day notice in the Federal Register
concerning each proposed collection of
information, including each proposed
extension or reinstatement of an existing
collection of information, before
submitting the collection to OMB for
approval. To comply with this
requirement, CMS is publishing this
notice.
1. Type of Information Collection
Request: Revision of a currently
approved collection; Title of
Information Collection: Implementation
of the Medicare Prescription Drug Plan
(PDP) and Medicare Advantage (MA)
Plan Disenrollment Reasons Survey;
Use: This data collection complements
the satisfaction data collected through
the Medicare Consumer Assessment of
Healthcare Providers and Systems
survey by providing dissatisfaction data
in the form of reasons for disenrollment
from a Prescription Drug Plan. The data
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collected in this survey can be used to
improve the operation of Medicare
Advantage (MA) (both MA and MA–PD)
contracts and standalone prescription
drug plans (PDPs) through the
identification of beneficiary
disenrollment reasons. Plans can use the
information to guide quality
improvement efforts. The data can also
be used by beneficiaries who need to
choose among the different MA and PDP
options. To the extent that these data
identify areas for improvement at the
contract level they can be used for
contract oversight. Form Number: CMS–
10316 (OMB control number: 0938–
1113); Frequency: Yearly; Affected
Public: Individuals or households;
Number of Respondents: 56,972; Total
Annual Responses: 56,972; Total
Annual Hours: 15,032. (For policy
questions regarding this collection
contact Beth Simon at 415–744–3780.)
Dated: March 22, 2016.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office
of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2016–06829 Filed 3–24–16; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifiers: CMS–855O, CMS–
10438, CMS–10439 and CMS–10440]
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
ACTION:
Notice.
The Centers for Medicare &
Medicaid Services (CMS) is announcing
an opportunity for the public to
comment on CMS’ intention to collect
information from the public. Under the
Paperwork Reduction Act of 1995
(PRA), federal agencies are required to
publish notice in the Federal Register
concerning each proposed collection of
information, including each proposed
extension or reinstatement of an existing
collection of information, and to allow
a second opportunity for public
comment on the notice. Interested
persons are invited to send comments
regarding the burden estimate or any
other aspect of this collection of
information, including any of the
following subjects: (1) The necessity and
utility of the proposed information
collection for the proper performance of
the agency’s functions; (2) the accuracy
of the estimated burden; (3) ways to
SUMMARY:
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25MRN1
asabaliauskas on DSK3SPTVN1PROD with NOTICES
Federal Register / Vol. 81, No. 58 / Friday, March 25, 2016 / Notices
enhance the quality, utility, and clarity
of the information to be collected; and
(4) the use of automated collection
techniques or other forms of information
technology to minimize the information
collection burden.
DATES: Comments on the collection(s) of
information must be received by the
OMB desk officer by April 25, 2016.
ADDRESSES: When commenting on the
proposed information collections,
please reference the document identifier
or OMB control number. To be assured
consideration, comments and
recommendations must be received by
the OMB desk officer via one of the
following transmissions: OMB, Office of
Information and Regulatory Affairs,
Attention: CMS Desk Officer, Fax
Number: (202) 395–5806, or Email:
OIRA_submission@omb.eop.gov.
To obtain copies of a supporting
statement and any related forms for the
proposed collection(s) summarized in
this notice, you may make your request
using one of following:
1. Access CMS’ Web site address at
https://www.cms.hhs.gov/
PaperworkReductionActof1995.
2. Email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov.
3. Call the Reports Clearance Office at
(410) 786–1326.
FOR FURTHER INFORMATION CONTACT:
Reports Clearance Office at (410) 786–
1326.
SUPPLEMENTARY INFORMATION: Under the
Paperwork Reduction Act of 1995 (PRA)
(44 U.S.C. 3501–3520), federal agencies
must obtain approval from the Office of
Management and Budget (OMB) for each
collection of information they conduct
or sponsor. The term ‘‘collection of
information’’ is defined in 44 U.S.C.
3502(3) and 5 CFR 1320.3(c) and
includes agency requests or
requirements that members of the public
submit reports, keep records, or provide
information to a third party. Section
3506(c)(2)(A) of the PRA (44 U.S.C.
3506(c)(2)(A)) requires federal agencies
to publish a 30-day notice in the
Federal Register concerning each
proposed collection of information,
including each proposed extension or
reinstatement of an existing collection
of information, before submitting the
collection to OMB for approval. To
comply with this requirement, CMS is
publishing this notice that summarizes
the following proposed collection(s) of
information for public comment:
1. Type of Information Collection
Request: Revision of a currently
approved information collection; Title
of Information Collection: Medicare
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Registration Application; Use: The
primary function of the CMS–855O is to
gather information from a physician or
other eligible professional to help CMS
determine whether he or she meets
certain qualifications to be enrolled in
the Medicare program for the sole
purpose of ordering or certifying certain
Medicare items or services and/or
prescribing Medicare Part D drugs for
Medicare beneficiaries. The application
allows a physician or other eligible
professional to enroll in Medicare
without being approved for billing
privileges. The required information is
submitted when the applicant requests
enrollment in Medicare for the sole
purpose of ordering and certifying
certain Medicare items and services or
for prescribing Medicare Part D drugs.
The application is used by Medicare
contractors to collect data to help ensure
that the applicant has the necessary
credentials to order and certify certain
Medicare items and services or to
prescribe Medicare Part D drugs. This
includes ensuring that the physician is
not excluded debarred from the
Medicare program. Form Number:
CMS–855O (OMB control number:
0938–1135); Frequency: Occasionally;
Affected Public: Private Sector (Business
or other for-profits), State, Local, or
Tribal Governments; Number of
Respondents: 448,000; Number of
Responses: 24,000; Total Annual Hours:
243,600. (For questions regarding this
collection contact Kimberly McPhillips
(410) 786–8438.)
2. Type of Information Collection
Request: Revision of a currently
approved information collection; Title
of Information Collection: Data
Collection to Support Eligibility
Determinations and Enrollment for
Employers in the Small Business Health
Options Program; Use: Section
1311(b)(1)(B) of the Affordable Care Act
directs that the SHOP assist qualified
small employers in facilitating the
enrollment of their employees in QHPs
offered in the small group market.
Section 1311(c)(1)(F) of the Affordable
Care Act directs HHS to establish
criteria for certification of health plans
as QHPs and plans to utilize a uniform
enrollment form for qualified
employers. Further, section
1311(c)(5)(B) directs HHS to develop a
Web site that assists employers in
determining if they are eligible to
participate in SHOP.
This proposed information collection
was previously published in the Federal
Register on December 11, 2015 (80 FR
76994) and allowed 60 days for public
comment. No comments were received.
Form Number: CMS–10439 (OMB
control number 0938–1194); Frequency:
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16185
Annually; Affected Public: Private
Sector; Number of Respondents: 6,000;
Number of Responses: 6,000; Total
Annual Hours: 12,000. (For questions
regarding this collection contact
Christelle Jang at (410) 786–8438.)
3. Type of Information Collection
Request: Revision of a currently
approved information collection; Title
of Information Collection: Data
Collection to Support Eligibility
Determinations and Enrollment for
Employers in the Small Business Health
Options Program; Use: Section
1311(b)(1)(B) of the Affordable Care Act
directs that the SHOP assist qualified
small employers in facilitating the
enrollment of their employees in QHPs
offered in the small group market.
Section 1311(c)(1)(F) of the Affordable
Care Act directs HHS to establish
criteria for certification of health plans
as QHPs and plans to utilize a uniform
enrollment form for qualified
employers. Further, section
1311(c)(5)(B) directs HHS to develop a
Web site that assists employers in
determining if they are eligible to
participate in SHOP.
This proposed information collection
was previously published in the Federal
Register on December 11, 2015 (80 FR
76994) and allowed 60 days for public
comment. No comments were received.
Form Number: CMS–10439 (OMB
Control Number 0938–1194); Frequency:
Annually; Affected Public: Private
Sector; Number of Respondents: 6,000;
Number of Responses: 6,000; Total
Annual Hours: 12,000. (For questions
regarding this collection contact
Christelle Jang at (410) 786–8438.)
4. Type of Information Collection
Request: Revision of a currently
approved information collection; Title
of Information Collection: Data
Collection to Support Eligibility
Determinations for Insurance
Affordability Programs and Enrollment
through Health Benefits Exchanges,
Medicaid and Children’s Health
Insurance Program Agencies; Use:
Section 1413 of the Affordable Care Act
directs the Secretary of Health and
Human Services to develop and provide
to each State a single, streamlined form
that may be used to apply for coverage
through the Exchange and Insurance
Affordability Programs, including
Medicaid, the Children’s Health
Insurance Program (CHIP), and the Basic
Health Program, as applicable. The
application must be structured to
maximize an applicant’s ability to
complete the form satisfactorily, taking
into account the characteristics of
individuals who qualify for the
programs. A State may develop and use
its own single streamlined application if
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Federal Register / Vol. 81, No. 58 / Friday, March 25, 2016 / Notices
approved by the Secretary in accordance
with section 1413 and if it meets the
standards established by the Secretary.
Section 155.405(a) of the Exchange
Final Rule (77 FR 18310) provides more
detail about the application that must be
used by the Exchange to determine
eligibility and to collect information
necessary for enrollment. The
regulations in § 435.907 and § 457.330
establish the requirements for State
Medicaid and CHIP agencies related to
the use of the single streamlined
application. CMS is designing the single
streamlined application to be a dynamic
electronic application that will tailor the
amount of data required from an
applicant based on the applicant’s
circumstances and responses to
particular questions. The paper version
of the application will not be able to be
tailored in the same way but is being
designed to collect only the data
required to determine eligibility.
Individuals will be able to submit an
application electronically, through the
mail, over the phone through a call
center, or in person, per § 155.405(c)(2)
of the Exchange Final Rule, as well as
through other commonly available
electronic means as noted in
§ 435.907(a) and § 457.330 of the
Medicaid Final Rule. The application
may be submitted to an Exchange,
Medicaid or CHIP agency. The
electronic application process will vary
depending on each applicant’s
circumstances, their experience with
health insurance applications and
online capabilities. The goal is to solicit
sufficient information so that in most
cases no further inquiry will be needed.
Form Number: CMS–10440 (OMB
control number: 0938–1191); Frequency:
Annually; Affected Public: Individuals
and Households; Number of
Respondents: 7,200,000; Total Annual
Responses: 7,200,000; Total Annual
Hours: 2,410,767. (For policy questions
regarding this collection contact Beth
Liu at 301–492–4135.)
asabaliauskas on DSK3SPTVN1PROD with NOTICES
Dated: March 22, 2016.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office
of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2016–06830 Filed 3–24–16; 8:45 am]
BILLING CODE 4120–01–P
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Jkt 238001
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
[Docket No. FDA–2016–D–0785]
General Principles for Evaluating the
Abuse Deterrence of Generic Solid
Oral Opioid Drugs Products; Draft
Guidance for Industry; Availability
AGENCY:
Food and Drug Administration,
HHS.
ACTION:
Notice of availability.
The Food and Drug
Administration (FDA) is announcing the
availability of a draft guidance for
industry entitled ‘‘General Principles for
Evaluating the Abuse Deterrence of
Generic Solid Oral Opioid Drug
Products.’’ This draft guidance
recommends studies, including
comparative in vitro studies, which
should be conducted to demonstrate
that a proposed generic solid oral opioid
drug product is no less abuse-deterrent
than its reference listed drug.
DATES: Although you can comment on
any guidance at any time (see 21 CFR
10.115(g)(5)), to ensure that the Agency
considers your comment on this draft
guidance before it begins work on the
final version of the guidance, submit
either electronic or written comments
on the draft guidance by May 24, 2016.
ADDRESSES: You may submit comments
as follows:
SUMMARY:
Electronic Submissions
Submit electronic comments in the
following way:
• Federal eRulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments.
Comments submitted electronically,
including attachments, to https://
www.regulations.gov will be posted to
the docket unchanged. Because your
comment will be made public, you are
solely responsible for ensuring that your
comment does not include any
confidential information that you or a
third party may not wish to be posted,
such as medical information, your or
anyone else’s Social Security number, or
confidential business information, such
as a manufacturing process. Please note
that if you include your name, contact
information, or other information that
identifies you in the body of your
comments, that information will be
posted on https://www.regulations.gov.
• If you want to submit a comment
with confidential information that you
do not wish to be made available to the
public, submit the comment as a
written/paper submission and in the
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manner detailed (see ‘‘Written/Paper
Submissions’’ and ‘‘Instructions’’).
Written/Paper Submissions
Submit written/paper submissions as
follows:
• Mail/Hand delivery/Courier (for
written/paper submissions): Division of
Dockets Management (HFA–305), Food
and Drug Administration, 5630 Fishers
Lane, Rm. 1061, Rockville, MD 20852.
• For written/paper comments
submitted to the Division of Dockets
Management, FDA will post your
comment, as well as any attachments,
except for information submitted,
marked and identified, as confidential,
if submitted as detailed in
‘‘Instructions.’’
Instructions: All submissions received
must include the Docket No. FDA–
2016–D–0785 for ‘‘General Principles
for Evaluating the Abuse-Deterrence of
Generic Solid Oral Opioid Drugs.’’
Received comments will be placed in
the docket and, except for those
submitted as ‘‘Confidential
Submissions,’’ publicly viewable at
https://www.regulations.gov or at the
Division of Dockets Management
between 9 a.m. and 4 p.m., Monday
through Friday.
• Confidential Submissions—To
submit a comment with confidential
information that you do not wish to be
made publicly available, submit your
comments only as a written/paper
submission. You should submit two
copies total. One copy will include the
information you claim to be confidential
with a heading or cover note that states
‘‘THIS DOCUMENT CONTAINS
CONFIDENTIAL INFORMATION.’’ The
Agency will review this copy, including
the claimed confidential information, in
its consideration of comments. The
second copy, which will have the
claimed confidential information
redacted/blacked out, will be available
for public viewing and posted on
https://www.regulations.gov. Submit
both copies to the Division of Dockets
Management. If you do not wish your
name and contact information to be
made publicly available, you can
provide this information on the cover
sheet and not in the body of your
comments and you must identify this
information as ‘‘confidential.’’ Any
information marked as ‘‘confidential’’
will not be disclosed except in
accordance with 21 CFR 10.20 and other
applicable disclosure law. For more
information about FDA’s posting of
comments to public dockets, see 80 FR
56469, September 18, 2015, or access
the information at: https://www.fda.gov/
regulatoryinformation/dockets/
default.htm.
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]]>Agencies
[Federal Register Volume 81, Number 58 (Friday, March 25, 2016)]
[Notices]
[Pages 16184-16186]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-06830]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifiers: CMS-855O, CMS-10438, CMS-10439 and CMS-10440]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is
announcing an opportunity for the public to comment on CMS' intention
to collect information from the public. Under the Paperwork Reduction
Act of 1995 (PRA), federal agencies are required to publish notice in
the Federal Register concerning each proposed collection of
information, including each proposed extension or reinstatement of an
existing collection of information, and to allow a second opportunity
for public comment on the notice. Interested persons are invited to
send comments regarding the burden estimate or any other aspect of this
collection of information, including any of the following subjects: (1)
The necessity and utility of the proposed information collection for
the proper performance of the agency's functions; (2) the accuracy of
the estimated burden; (3) ways to
[[Page 16185]]
enhance the quality, utility, and clarity of the information to be
collected; and (4) the use of automated collection techniques or other
forms of information technology to minimize the information collection
burden.
DATES: Comments on the collection(s) of information must be received by
the OMB desk officer by April 25, 2016.
ADDRESSES: When commenting on the proposed information collections,
please reference the document identifier or OMB control number. To be
assured consideration, comments and recommendations must be received by
the OMB desk officer via one of the following transmissions: OMB,
Office of Information and Regulatory Affairs, Attention: CMS Desk
Officer, Fax Number: (202) 395-5806, or Email:
OIRA_submission@omb.eop.gov.
To obtain copies of a supporting statement and any related forms
for the proposed collection(s) summarized in this notice, you may make
your request using one of following:
1. Access CMS' Web site address at https://www.cms.hhs.gov/PaperworkReductionActof1995.
2. Email your request, including your address, phone number, OMB
number, and CMS document identifier, to Paperwork@cms.hhs.gov.
3. Call the Reports Clearance Office at (410) 786-1326.
FOR FURTHER INFORMATION CONTACT: Reports Clearance Office at (410) 786-
1326.
SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995
(PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from
the Office of Management and Budget (OMB) for each collection of
information they conduct or sponsor. The term ``collection of
information'' is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and
includes agency requests or requirements that members of the public
submit reports, keep records, or provide information to a third party.
Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires
federal agencies to publish a 30-day notice in the Federal Register
concerning each proposed collection of information, including each
proposed extension or reinstatement of an existing collection of
information, before submitting the collection to OMB for approval. To
comply with this requirement, CMS is publishing this notice that
summarizes the following proposed collection(s) of information for
public comment:
1. Type of Information Collection Request: Revision of a currently
approved information collection; Title of Information Collection:
Medicare Registration Application; Use: The primary function of the
CMS-855O is to gather information from a physician or other eligible
professional to help CMS determine whether he or she meets certain
qualifications to be enrolled in the Medicare program for the sole
purpose of ordering or certifying certain Medicare items or services
and/or prescribing Medicare Part D drugs for Medicare beneficiaries.
The application allows a physician or other eligible professional to
enroll in Medicare without being approved for billing privileges. The
required information is submitted when the applicant requests
enrollment in Medicare for the sole purpose of ordering and certifying
certain Medicare items and services or for prescribing Medicare Part D
drugs. The application is used by Medicare contractors to collect data
to help ensure that the applicant has the necessary credentials to
order and certify certain Medicare items and services or to prescribe
Medicare Part D drugs. This includes ensuring that the physician is not
excluded debarred from the Medicare program. Form Number: CMS-855O (OMB
control number: 0938-1135); Frequency: Occasionally; Affected Public:
Private Sector (Business or other for-profits), State, Local, or Tribal
Governments; Number of Respondents: 448,000; Number of Responses:
24,000; Total Annual Hours: 243,600. (For questions regarding this
collection contact Kimberly McPhillips (410) 786-8438.)
2. Type of Information Collection Request: Revision of a currently
approved information collection; Title of Information Collection: Data
Collection to Support Eligibility Determinations and Enrollment for
Employers in the Small Business Health Options Program; Use: Section
1311(b)(1)(B) of the Affordable Care Act directs that the SHOP assist
qualified small employers in facilitating the enrollment of their
employees in QHPs offered in the small group market. Section
1311(c)(1)(F) of the Affordable Care Act directs HHS to establish
criteria for certification of health plans as QHPs and plans to utilize
a uniform enrollment form for qualified employers. Further, section
1311(c)(5)(B) directs HHS to develop a Web site that assists employers
in determining if they are eligible to participate in SHOP.
This proposed information collection was previously published in
the Federal Register on December 11, 2015 (80 FR 76994) and allowed 60
days for public comment. No comments were received. Form Number: CMS-
10439 (OMB control number 0938-1194); Frequency: Annually; Affected
Public: Private Sector; Number of Respondents: 6,000; Number of
Responses: 6,000; Total Annual Hours: 12,000. (For questions regarding
this collection contact Christelle Jang at (410) 786-8438.)
3. Type of Information Collection Request: Revision of a currently
approved information collection; Title of Information Collection: Data
Collection to Support Eligibility Determinations and Enrollment for
Employers in the Small Business Health Options Program; Use: Section
1311(b)(1)(B) of the Affordable Care Act directs that the SHOP assist
qualified small employers in facilitating the enrollment of their
employees in QHPs offered in the small group market. Section
1311(c)(1)(F) of the Affordable Care Act directs HHS to establish
criteria for certification of health plans as QHPs and plans to utilize
a uniform enrollment form for qualified employers. Further, section
1311(c)(5)(B) directs HHS to develop a Web site that assists employers
in determining if they are eligible to participate in SHOP.
This proposed information collection was previously published in
the Federal Register on December 11, 2015 (80 FR 76994) and allowed 60
days for public comment. No comments were received. Form Number: CMS-
10439 (OMB Control Number 0938-1194); Frequency: Annually; Affected
Public: Private Sector; Number of Respondents: 6,000; Number of
Responses: 6,000; Total Annual Hours: 12,000. (For questions regarding
this collection contact Christelle Jang at (410) 786-8438.)
4. Type of Information Collection Request: Revision of a currently
approved information collection; Title of Information Collection: Data
Collection to Support Eligibility Determinations for Insurance
Affordability Programs and Enrollment through Health Benefits
Exchanges, Medicaid and Children's Health Insurance Program Agencies;
Use: Section 1413 of the Affordable Care Act directs the Secretary of
Health and Human Services to develop and provide to each State a
single, streamlined form that may be used to apply for coverage through
the Exchange and Insurance Affordability Programs, including Medicaid,
the Children's Health Insurance Program (CHIP), and the Basic Health
Program, as applicable. The application must be structured to maximize
an applicant's ability to complete the form satisfactorily, taking into
account the characteristics of individuals who qualify for the
programs. A State may develop and use its own single streamlined
application if
[[Page 16186]]
approved by the Secretary in accordance with section 1413 and if it
meets the standards established by the Secretary.
Section 155.405(a) of the Exchange Final Rule (77 FR 18310)
provides more detail about the application that must be used by the
Exchange to determine eligibility and to collect information necessary
for enrollment. The regulations in Sec. 435.907 and Sec. 457.330
establish the requirements for State Medicaid and CHIP agencies related
to the use of the single streamlined application. CMS is designing the
single streamlined application to be a dynamic electronic application
that will tailor the amount of data required from an applicant based on
the applicant's circumstances and responses to particular questions.
The paper version of the application will not be able to be tailored in
the same way but is being designed to collect only the data required to
determine eligibility. Individuals will be able to submit an
application electronically, through the mail, over the phone through a
call center, or in person, per Sec. 155.405(c)(2) of the Exchange
Final Rule, as well as through other commonly available electronic
means as noted in Sec. 435.907(a) and Sec. 457.330 of the Medicaid
Final Rule. The application may be submitted to an Exchange, Medicaid
or CHIP agency. The electronic application process will vary depending
on each applicant's circumstances, their experience with health
insurance applications and online capabilities. The goal is to solicit
sufficient information so that in most cases no further inquiry will be
needed. Form Number: CMS-10440 (OMB control number: 0938-1191);
Frequency: Annually; Affected Public: Individuals and Households;
Number of Respondents: 7,200,000; Total Annual Responses: 7,200,000;
Total Annual Hours: 2,410,767. (For policy questions regarding this
collection contact Beth Liu at 301-492-4135.)
Dated: March 22, 2016.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2016-06830 Filed 3-24-16; 8:45 am]
BILLING CODE 4120-01-P
