Daily Rules, Proposed Rules, and Notices of the Federal Government


Centers for Medicare & Medicaid Services

[Document Identifier CMS-10408]

Agency Information Collection Activities: Proposed Collection; Comment Request

AGENCY: In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid Services (CMS) is publishing the following summary of proposed collections for public comment. Interested persons are invited to send comments regarding this 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 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.

1.Type of Information Collection Request:New collection;Title of Information Collection:Early Retiree Reinsurance Program Survey of Plan Sponsors;Use:Under the Patient Protection and Affordable Care Act (42 U.S.C. 18002) and implementing regulations at 45 CFR part 149, employment-based plans that offer health coverage to early retirees and their spouses, surviving spouses, and dependents are eligible to receive tax-free reimbursement for a portion of the costs of health benefits provided to such individuals. The statute limits how the reimbursement funds can be used, and requires the Secretary of HHS to develop a mechanism to monitor the appropriate use of such funds. The survey that is the subject of this PRA package, is part of that mechanism.Form Number:CMS-10408 (OMB 0938-New);Frequency:Yearly;Affected Public:Private Sector: Business or other for-profit and not-for-profit institutions;Number of Respondents:3,130;Total Responses:3,130;Total Hours:34,430. (For policy questions regarding this collection contact Catherine Kelly at 301-492-4156. For all other issues call 410-786-1326.)

To obtain copies of the supporting statement and any related forms for the proposed paperwork collections referenced above, access CMS' Web Site address at,or e-mail your request, including your address, phone number, OMB number, and CMS document identifier,,or call the Reports Clearance Office on (410) 786-1326.

In commenting on the proposed information collections please reference the document identifier or OMB control number. To be assured consideration, comments and recommendations must be submitted in one of the following ways byNovember 8, 2011:

1.Electronically.You may submit your comments electronically to the instructions for "Comment or Submission" or "More Search Options" to find the information collection document(s) 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 ControlNumber ____ ,Room C4-26-05,7500 Security Boulevard,Baltimore, Maryland 21244-1850.

Dated: September 6, 2011. Martique Jones, Director, Regulations Development Group, Division B,Office of Strategic Operations and Regulatory Affairs.