Application

Temporary High Risk Pool Program (CMS-10319)

OMB: 0938-1085

IC ID: 192807

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Application
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10319 CMS - 10319 - Full Solicitation for State Proposals State High Risk Pool Solicitation-FINAL.docx Yes Yes Fillable Fileable Signable

Health Health Care Services

 

51 0
   
State, Local, and Tribal Governments
 
   100 %

  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 51 51 0 0 0 0
Annual IC Time Burden (Hours) 34,884 34,884 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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