Early Retiree Reinsurance Program - Public Application

Early Retiree Reinsurance Program

OMB: 0938-1087

IC ID: 192754

Information Collection (IC) Details

View Information Collection (IC)

Early Retiree Reinsurance Program - Public Application
 
No New
 
Mandatory
 
45 CFR 149.40

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10321 ERRP Application CMS-10321.collection instrument.docx Yes No Fillable Fileable
Instruction CMS-10321.Application Instructions.docx Yes No Fillable Fileable

Health Health Care Services

 

1,500 0
   
State, Local, and Tribal Governments
 
   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 1,500 1,500 0 0 0 0
Annual IC Time Burden (Hours) 52,500 52,500 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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