Recovery Act of 2009 - Request for Expedited Review of Denial of Premium Assistance

Recovery Act of 2009 - Request for Expedited Review of Denial of Premium Assistance

OMB: 0938-1062

IC ID: 189030

Information Collection (IC) Details

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Recovery Act of 2009 - Request for Expedited Review of Denial of Premium Assistance
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10285 Request for Expedited Review of Denial of Premium Assistance COBRA_Req_Rev_5_20_09_CPC .doc Yes Yes Paper Only

Health Health Care Services

 

12,000 0
   
Individuals or Households
 
   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 12,000 12,000 0 0 0 0
Annual IC Time Burden (Hours) 12,000 12,000 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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