Information Collection

Mandatory Insurer Reporting (GHP-State, Local, Tribal Gov't)

IC 188575 under ICR 200903-0938-009 · OMB 0938-1074.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1074 can be found here:

Documents and Forms

Document Name Document Type
GHPUserGuide121708[1].pdf Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Mandatory Insurer Reporting (GHP-State, Local, Tribal Gov't)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			GHPUserGuide121708[1].pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Medicare Advantage Prescription Drug System (MARx)	FR Citation: 70 FR 60530

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	185,000	185,000
Annual IC Time Burden (Hours)	15,417	15,417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.