CHIPRA-Children's Health Insurance Program Reauthorization Act of 2009 -ELE

Forms and Documents

Document Name	Status
ATTACHMENT A_CHIPRA ELE Legislation.docx Supplementary Document	2012-08-07
ATTACHMENT F.2. 51 state survey recruiting email text.docx Supplementary Document	2012-08-07
ATTACHMENT I_CHIPRA ELE_30dayFR Comments Placeholder.doc Supplementary Document	2012-08-07
ATTACHMENT L_Contractor Confidentiality Pledge.pdf Supplementary Document	2012-08-07
Attachment H 60 Day FRN Notice Published 2 2 2012.pdf Supplementary Document	2012-08-07
14. ATTACHMENT N.2. Pretest report on quarterly calls.docx Supplementary Document	2012-07-13
13. ATTACHMENT N.1 Pretest memo on 51 State Survey.docx Supplementary Document	2012-07-13
12. NEW ATTACHMENT O. CHIPRA Express Lane Eligibility Evaluation Full Approval Letter.pdf Supplementary Document	2012-07-13
11. ATTACHMENT M_CHIPRA ELE Evaluation Final Design and Work Plan Part 1.docx Supplementary Document	2012-07-13
10. ATTACHMENT J_TAG members.docx Supplementary Document	2012-07-13
9 REVISED ATTACHMENT K 4_Comments.doc Supplementary Document	2012-07-13
8 REVISED ATTACHMENT K 3_Comments.doc Supplementary Document	2012-07-13
7 REVISED ATTACHMENT K 2_Comments.doc Supplementary Document	2012-07-13
6 REVISED ATTACHMENT K 1_COMMENTS.doc Supplementary Document	2012-07-13
0990-CHIPRA_ELE_Study_Part_B_Statement__FINAL_8_6_12.docx Supporting Statement B	2012-08-13
0990-_CHIPRA_ELE_Study_Part_A_Statement_Final_8.6.12.docx Supporting Statement A	2012-08-13

IC Document Collections

IC ID	Document Title	Status
202108	Key Informants (Quarterly Monitoring Calls) Other-interview	New
202107	Medicaid and CHIP Officials Other-ATTACHMENT F.1.SCREEN SHOTS.HMA. 51 state survey form Q 8	New
202106	Moderator"s Guide Other-REVISED.ATTACHMENT E1_ELE Focus Group Moderator Guide and	New
202105	Local - Level Key Informant (ELE) Other-study	New
202104	State - Level Key Informants- ELE States Other-study	New
202103	Staff for Enrollment Data Collection Other-REVISED ATTACHMENT C ENROLLMENT EXTRACTION FORM IN EXCEL	New
202102	Staff for Administrative Cost Data Collection Other-survey	New

ICR Details

OMB Control No: 0990-0400	ICR Reference No: 201204-0990-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: CHIPRA-Children's Health Insurance Program Reauthorization Act of 2009 -ELE
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/13/2012
	Date Received in OIRA: 04/30/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2015	36 Months From Approved
Responses	692	0	0
Time Burden (Hours)	1,051	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: As part of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Congress authorized a new policy known as Express Lane Eligibility (ELE). With ELE, a state's Medicaid and/or Children's Health Insurance Program (CHIP) can rely on another agency's eligibility findings to qualify children for CHIP or Medicaid health coverage, despite their different methods of assessing income or otherwise determining eligibility. As part of CHIPRA, Congress also mandated an extensive, rigorous evaluation of ELE, creating an exceptional opportunity to document ELE implementation across states and to assess the changes to coverage or administrative costs that may have resulted. The evaluation also provides an opportunity to understand other methods of simplified enrollment that states have been pursuing and to assess the benefits and potential costs of these methods compared to those of ELE.

---

Authorizing Statute(s): PL: Pub.L. 21 - 111 3 Name of Law: CHILDREN'S HEALTH INSURANCE PROGRAM
  

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:
	77 FR 5253	02/02/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 24206	04/23/2012
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
Staff for Administrative Cost Data Collection
Staff for Enrollment Data Collection
State - Level Key Informants- ELE States
Local - Level Key Informant (ELE)
Moderator"s Guide
Medicaid and CHIP Officials
Key Informants (Quarterly Monitoring Calls)

---

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	692	0	0	692	0	0
Annual Time Burden (Hours)	1,051	0	0	1,051	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: New collection

---

Annual Cost to Federal Government: $2,361,535

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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

---

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: 04/30/2012

---