(149.500 & 149.510) - Requesting Appeals

Early Retiree Reinsurance Program

Documents and Forms

Document Name Document Type
ERRP Appeals Guidance.pdf Instruction
0938-1087.Revised_ERRP_Appeals_Guidance.docx Instruction

Information Collection (IC) Details

IC Title:	(149.500 & 149.510) - Requesting Appeals	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 149.500 45 CFR 149.510

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			0938-1087.Revised_ERRP_Appeals_Guidance.docx		Yes	No	Printable Only
Instruction			ERRP Appeals Guidance.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Early Retiree Reinsurance Program	FR Citation: 75 FR 31440

Number of Respondents: 143	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 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	143	143
Annual IC Time Burden (Hours)	1,144	1,144
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.