Private CHOW Years 2_3_4

Early Retiree Reinsurance Program

OMB: 0938-1087

IC ID: 192768

Information Collection (IC) Details

View Information Collection (IC)

Private CHOW Years 2_3_4
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 149.700

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10321 Revised ERRP Collection Instrument 0938-1087 Revised ERRP Collection Instrument-1.docx Yes No Fillable Fileable
Instruction 0938-1087 Revised_Instrument Collection Instructions.docx Yes No Fillable Fileable

Health Health Care Services

 

38 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 38 0 0 -4 0 42
Annual IC Time Burden (Hours) 38 0 0 -4 0 42
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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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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