Information Collection Request

Mandatory Insurer Reporting Requirements of Section 111 of the Medicare, Medicaid and SCHIP Act of 2007

ICR 200903-0938-009 · OMB 0938-1074 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10265 Interim Non-GHP Record Layout Form and Instruction New Available
Form CMS-10265 Interim Non-GHP Record Layout Form and Instruction New Available
Form CMS-10265 Interim Non-GHP Record Layout Form and Instruction New Available
Form CMS-10265 Interim Non-GHP Record Layout Form and Instruction New Repair queued
Form CMS-10265 Interim Non-GHP Record Layout Form and Instruction New Repair queued
Form CMS-10265 Interim Non-GHP Record Layout Form and Instruction New Available
CMS-10265 Burden Table-FINAL.doc Supplementary Document Uploaded 2009-10-29 Available
Sect 111_PRA_Responses_12-17-08.doc Supplementary Document Uploaded 2009-02-25 Available
Revised_Attachment C_1.16.09.doc Supplementary Document Uploaded 2009-02-17 Available
Revised_AttachmentA_1.16.09.doc Supplementary Document Uploaded 2009-02-17 Available
Revised_Attachment D_1.16.09.doc Supplementary Document Uploaded 2009-02-17 Available
CMS-10265.Supporting Statement Part A.doc Supporting Statement A Uploaded 2009-02-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
188585 Mandatory Insurer Reporting (Non-GHP, Federal, System Set-up and Administrative) Form and Instruction NewInterim Non-GHP Record Layout
188584 Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt., System Set-up and Administration) Form and Instruction NewInterim Non-GHP Record Layout
188583 Mandatory Insurer Reporting (Non-GHP, Private - System Set-up and Administration) Form and Instruction NewInterim Non-GHP Record Layout
188582 Mandatory Insurer Reporting (Non-GHP, Federal) Form and Instruction NewInterim Non-GHP Record Layout
188581 Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt.) Form and Instruction NewInterim Non-GHP Record Layout
188580 Mandatory Insurer Reporting (Non-GHP, Private) Form and Instruction NewInterim Non-GHP Record Layout
188579 Mandatory Insurer Reporting (State, Local, Tribal Govt., Administrative) Instruction New
188578 Mandatory Insurer Reporting (Private, Administrative) Instruction New
188577 Mandatory Insurer Reporting (State, Local, Tribal Govt, System Set-up) Instruction New
188576 Mandatory Insurer Reporting (Private, System Set-up) Instruction New
188575 Mandatory Insurer Reporting (GHP-State, Local, Tribal Gov't) Instruction New
188574 Mandatory Insurer Reporting (GHP-Private) Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2012 36 Months From Approved
6,920,504 0 0
2,120,478 0 0
0 0 0





table that charts list 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 6,920,504 0 6,920,504 0 0 0
Annual Time Burden (Hours) 2,120,478 0 2,120,478 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No