Reimbursement Requests (Public)

Early Retiree Reinsurance Program

OMB: 0938-1087

IC ID: 192769

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Information Collection (IC) Details

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Reimbursement Requests (Public)
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 149.335

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

Early Retirement Reinsurance Program  75 FR 31440

3,375 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 6,750 0 0 1,350 0 5,400
Annual IC Time Burden (Hours) 594,000 0 0 118,800 0 475,200
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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