Information Collection

Grants to States for Health Insurance Premium Review

IC 193172 under ICR 201006-0938-002 · OMB 0938-1092.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1092 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10323 Grants to States for Health Insurance Premium Review Form and Instruction
CMS-10323 Grants to States for Health Insurance Premium Review CMS-10323.Premium Review Grant Solicitation with Disclosure Statement .docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Grants to States for Health Insurance Premium Review	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
Form and Instruction	CMS-10323	Grants to States for Health Insurance Premium Review	CMS-10323.Premium Review Grant Solicitation with Disclosure Statement .docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	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	51	51
Annual IC Time Burden (Hours)	26,520	26,520
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.