Information Collection

Early Retiree Reinsurance Program - Private Application

IC 192755 under ICR 201106-0938-023 · OMB 0938-1087.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1087 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10321 Deliberative Document Early Retiree Reinsurance Program - Private Application	Form
0938-1087.Deliberative Document.docx	Instruction
CMS-10321 Deliberative Document 0938-1087.Deliberative Document.docx	Form

IC Title:

Early Retiree Reinsurance Program - Private Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 149.40

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10321				Yes	No	Fillable Fileable
Instruction					Yes	No	Fillable Fileable

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: 4,125

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-4,125	4,125
Annual IC Time Burden (Hours)	-90,750	90,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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