OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Early Retiree Reinsurance Program Reopening Requests (Pub lic), for Program Years 2, 3, 4

IC 199567 under ICR 201106-0938-023 · OMB 0938-1087.

Documents and Forms
Document Name
Document Type
Form
Instruction
Form
Information Collection (IC) Details

View Information Collection (IC)

Early Retiree Reinsurance Program Reopening Requests (Pub lic), for Program Years 2, 3, 4
 
No New
 
Required to Obtain or Retain Benefits
 
45 CFR 149 Subpart E

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

Early Retiree Reinsurance Program  75 FR 31440

10 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 10 0 0 10 0 0
Annual IC Time Burden (Hours) 80 0 0 80 0 0
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.