OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

ICR 201106-0938-008 · OMB 0938-1141 · Public filing

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Preliminary Instructions.pdf Supplementary Document Uploaded 2011-08-23 Available
Preliminary Justification Submission Function.docx Supplementary Document Uploaded 2011-08-23 Available
issuer_module_1_reporting_requirements_slides.pdf Supplementary Document Uploaded 2011-08-19 Available
CMS-10379.Rate Summary Form (7-12-11) w comment changes highlighted.xls Supplementary Document Uploaded 2011-07-20 Available
CMS-10379.PJ Instructions (7-12-11).doc Supplementary Document Uploaded 2011-07-20 Available
CMS-10379.KY examples (7-12-11).xlsx Supplementary Document Uploaded 2011-07-20 Available
CMS-10379.Examples (7-12-11).pdf Supplementary Document Uploaded 2011-07-20 Available
CMS-10379.Discussion of the examples (7-12-11).docx Supplementary Document Uploaded 2011-07-20 Available
CMS-10379.Synopsis of Comments on the PRA package (7-12-11).docx Supplementary Document Uploaded 2011-07-20 Available
Consumer Disclosure.pdf Supplementary Document Uploaded 2011-06-08 Available
Rate Summary Worksheet.pdf Supplementary Document Uploaded 2011-06-08 Available
PRA Response to Comments_052411.docx Supplementary Document Uploaded 2011-06-08 Available
CMS-10379.REVISED (CLEAN) Supporting Statement Part A (8-19-11).doc Supporting Statement A Uploaded 2011-08-22 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
198023 Ongoing Compliance (2012-2013) New
198022 State Unreasonable Rate Increase Determinations New
198021 One-Time Health Insurance Issuer Start-Up Costs New
198020 Health Insurance Issuer Submission of Final Justification for Unreasonable Rate Increases Other-Word Document New
198019 Health Insurance Issuer Submission of the Preliminary Justification Other-Word Document New

ICR Details

Record metadata
OMB Control No0938-1141