OMB
.report
Search
Reimbursement Requests (Public)
Early Retiree Reinsurance Program
OMB: 0938-1087
IC ID: 192769
OMB.report
HHS/CMS
OMB 0938-1087
ICR 201012-0938-015
IC 192769
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1087 can be found here:
2012-02-14 - Revision of a currently approved collection
2011-06-29 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Reimbursement Requests (Public)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
45 CFR 149.335
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
Early Retirement Reinsurance Program
FR Citation:
75 FR 31440
Number of Respondents:
3,375
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
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.