Survey of Plan Sponsors (Private Entities)

Early Retiree Reinsurance Program: Survey of Plan Sponsors

OMB: 0938-1150

IC ID: 200146

Information Collection (IC) Details

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Survey of Plan Sponsors (Private Entities)
 
No New
 
Voluntary
 
45 CFR 149.200

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10408 Final Survey CMS_Sample_Survey.pdf Yes No Fillable Printable
Instruction CMS-10408.Final Draft Survey Instructions (11-23-11).pdf Yes No Printable Only

Health Health Care Services

Early Retiree Reinsurance Program  75 FR 31440

1,038 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 1,038 0 1,038 0 0 0
Annual IC Time Burden (Hours) 11,418 0 11,418 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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