OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Data Submission for the Federally-facilitated Exchange User Fee Adjustment (CMS-10492)

ICR 202606-0938-010 · OMB 0938-1285 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-10492 Notice of Availability of Separate Contraception Payments from Fully Insured Issuers Form and Instruction Modified Available
Form CMS-10492 Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services Form and Instruction Modified Available
Form CMS-10492 Issuers' Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment Form and Instruction Modified Available
Form CMS-10492 Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services Form and Instruction Modified Available
Form CMS-10492 Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment Form and Instruction Modified Available
CMS-10492 - 60-day comment.docx Public Comments Uploaded 2026-06-10 Available
CMS-10492 - Response to comments.docx Supplementary Document Uploaded 2026-06-10 Available
CMS-10492 - Supporting Statement.docx Supporting Statement A Uploaded 2026-06-10 Available
IC Document Collections
IC IDCollectionTypeStatusForm
217425 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers) Form and Instruction ModifiedNotice of Availability of Separate Contraception Payments from Fully Insured Issuers
217424 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer) Form and Instruction ModifiedThird Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services
217424 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer) Form and Instruction ModifiedIssuers' Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment
217422 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs) Form and Instruction ModifiedThird Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services
217422 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs) Form and Instruction ModifiedData Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment
ICR Details
0938-1285 202606-0938-010
Received in OIRA 202208-0938-009
HHS/CMS CCIIO
Data Submission for the Federally-facilitated Exchange User Fee Adjustment (CMS-10492)
Reinstatement with change of a previously approved collection   No
Regular 06/10/2026
  Requested Previously Approved
36 Months From Approved
315 0
1,340 0
0 0
CMS will use the data collections from participating issuers and third party administrators to verify the total dollar amount for such payments for contraceptive services provided under this accommodation for the purpose of determining a participating issuer's user fee adjustment. The attestation that the payments for contraceptive services were made in compliance with 26 CFR 54.9815-2713A(b)(2) or 29 CFR 2590.715-2713A(b)(2) will help ensure that the user fee adjustment is being utilized to provide contraceptive services for the self-insured plans in accordance with the previously noted accommodation.
PL: Pub.L. 78 - 410 2713 Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 148 1321 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1311 Name of Law: Affordable Care Act
  
PL: Pub.L. 111 - 148 2713 Name of Law: Affordable Care Act
Not associated with rulemaking
  90 FR 57199 12/10/2025
91 FR 32978 06/02/2026
No
  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 315 0 0 0 -10 325
Annual Time Burden (Hours) 1,340 0 0 0 -110 1,450
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Based on the past years of experience with the collection of the contraceptive user fee adjustment data, we reduced the estimated number of participating issuers, from 40 to 30, which subsequently reduced the total number of burden hours (from 1,450 to 1,340). Wage rate estimates have also changed; therefore, costs per hour have been adjusted according to the most recently available BLS wage rates.
$96,232
No
    No
    No
Yes
No
No
No
Jamaa Hill 301 492-4190
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/10/2026