Health Insurance Benefit Agreement and Supporting Regulations at 42 CFR Part 489 and 491

Health Insurance Benefit Agreement and Supporting Regulations at 42 CFR Part 489 and 491

OMB: 0938-0832

IC ID: 8630

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Health Insurance Benefit Agreement and Supporting Regulations at 42 CFR Part 489 and 491
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-1561A No No
Form CMS-1561 No No


    

3,300 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,300 0 0 300 0 3,000
Annual IC Time Burden (Hours) 275 0 0 125 0 150
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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