Proposal Modification

Pre-Existing Condition Insurance Plan and Supporting Regulations

OMB: 0938-1100

IC ID: 193926

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Proposal Modification
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10339 State Solicitation CMS-10339.state_solicitation.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10339 Template Contract CMS-10339.HHS Template Contract.docx Yes Yes Fillable Fileable

Health Health Care Services

 

51 0
   
State, Local, and Tribal Governments
 
   0 %

  Requested 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 0 0 0 0 51
Annual IC Time Burden (Hours) 1,224 0 0 0 0 1,224
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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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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