Information Collection Request

Health Care Reform Insurance Web Portal and Supporting Authority Contained in Sections 1103 and 10102 of The Patient Protection and Affordability Care Act, P.L. 111-148 (PPACA)

ICR 201212-0938-005 · OMB 0938-1086 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10320 10350\10320\Files for 30-day 8-7-12\CMS-10320 Appendix_D_BenefitsPremiumsInformation Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_C_InsuranceIssuers Form and Instruction Modified Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_D_BenefitsPremiumsInformation Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_C_InsuranceIssuers Form and Instruction Modified Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction Modified Repair queued
Form CMS-10320 CMS-10320 Appendix_D_BenefitsPremiumsInformation Form and Instruction Modified Repair queued
Form CMS-10320 CMS-10320 Appendix_C_InsuranceIssuers Form and Instruction Modified Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction Modified Repair queued
Form CMS-10320 CMS-10320 Appendix_D_BenefitsPremiumsInformation Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_C_InsuranceIssuers Form and Instruction Modified Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_D_BenefitsPremiumsInformation Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_C_InsuranceIssuers Form and Instruction Modified Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction Modified Repair queued
Form CMS-10320 CMS-10320 Appendix_D_BenefitsPremiumsInformation20120801 Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_C_InsuranceIssuers Form and Instruction Modified Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_D_BenefitsPremiumsInformation Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_C_InsuranceIssuers Form and Instruction Modified Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_D_BenefitsPremiumsInformation Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_C_InsuranceIssuers Form and Instruction Modified Repair queued
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_D_BenefitsPremiumsInformation Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_C_InsuranceIssuers Form and Instruction Modified Available
Form CMS-10320 CMS-10320.Issuer - FINAL Instructions and Instruments Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_E_StateRequirements Form and Instruction Modified Available
Form CMS-10320 CMS-10320.FINAL State Instructions and Instrument Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_E_StateRequirements Form and Instruction Modified Available
Form CMS-10320 CMS-10320.FINAL State Instructions and Instrument (5-5-10). Form and Instruction Modified Available
Form CMS-10320 CMS-10320 Appendix_E_StateRequirements Form and Instruction Modified Available
Form CMS-10320 CMS-10320.FINAL State Instructions and Instrument (5-5-10). Form and Instruction Modified Available
CMS-10320 CCIIO_PRA_Comment_Replies_20122731.pdf Supplementary Document Uploaded 2012-12-05 Available
CMS-10320 Appendix_F_PoolRequirements.pdf Supplementary Document Uploaded 2012-12-05 Available
CMS-10320 Appendix_B_Section1103.pdf Supplementary Document Uploaded 2012-12-05 Available
CMS-10320 Appendix_A_Supporting_Statement20120801.pdf Supporting Statement A Uploaded 2012-12-05 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
199284 Issuer - Attest (Small Group) Form and Instruction Modified10350\10320\Files for 30-day 8-7-12\CMS-10320 Appendix_D_BenefitsPremiumsInformation
199284 Issuer - Attest (Small Group) Form and Instruction ModifiedCMS-10320 Appendix_C_InsuranceIssuers
199284 Issuer - Attest (Small Group) Form and Instruction ModifiedCMS-10320.Issuer - FINAL Instructions and Instruments
199283 Issuer - Attest (Individual) Form and Instruction ModifiedCMS-10320 Appendix_D_BenefitsPremiumsInformation
199283 Issuer - Attest (Individual) Form and Instruction ModifiedCMS-10320 Appendix_C_InsuranceIssuers
199283 Issuer - Attest (Individual) Form and Instruction ModifiedCMS-10320.Issuer - FINAL Instructions and Instruments
199282 Issuer - Troubleshoot (Small Group) Form and Instruction ModifiedCMS-10320 Appendix_D_BenefitsPremiumsInformation
199282 Issuer - Troubleshoot (Small Group) Form and Instruction ModifiedCMS-10320 Appendix_C_InsuranceIssuers
199282 Issuer - Troubleshoot (Small Group) Form and Instruction ModifiedCMS-10320.Issuer - FINAL Instructions and Instruments
199281 Issuer - Troubleshoot (Individual) Form and Instruction ModifiedCMS-10320 Appendix_D_BenefitsPremiumsInformation
199281 Issuer - Troubleshoot (Individual) Form and Instruction ModifiedCMS-10320 Appendix_C_InsuranceIssuers
199281 Issuer - Troubleshoot (Individual) Form and Instruction ModifiedCMS-10320.Issuer - FINAL Instructions and Instruments
199280 Issuer - Data Entry (Small Group) Form and Instruction ModifiedCMS-10320 Appendix_D_BenefitsPremiumsInformation
199280 Issuer - Data Entry (Small Group) Form and Instruction ModifiedCMS-10320 Appendix_C_InsuranceIssuers
199280 Issuer - Data Entry (Small Group) Form and Instruction ModifiedCMS-10320.Issuer - FINAL Instructions and Instruments
199279 Issuer - Data Entry (Individual) Form and Instruction ModifiedCMS-10320 Appendix_D_BenefitsPremiumsInformation20120801
199279 Issuer - Data Entry (Individual) Form and Instruction ModifiedCMS-10320 Appendix_C_InsuranceIssuers
199279 Issuer - Data Entry (Individual) Form and Instruction ModifiedCMS-10320.Issuer - FINAL Instructions and Instruments
199278 Issuers - Submission Preparation (Small Group) Form and Instruction ModifiedCMS-10320 Appendix_D_BenefitsPremiumsInformation
199278 Issuers - Submission Preparation (Small Group) Form and Instruction ModifiedCMS-10320 Appendix_C_InsuranceIssuers
199278 Issuers - Submission Preparation (Small Group) Form and Instruction ModifiedCMS-10320.Issuer - FINAL Instructions and Instruments
199277 Issuers - Submission Preparation (Individual) Form and Instruction ModifiedCMS-10320 Appendix_D_BenefitsPremiumsInformation
199277 Issuers - Submission Preparation (Individual) Form and Instruction ModifiedCMS-10320 Appendix_C_InsuranceIssuers
199277 Issuers - Submission Preparation (Individual) Form and Instruction ModifiedCMS-10320.Issuer - FINAL Instructions and Instruments
199276 Issuers Training and Communication Form and Instruction ModifiedCMS-10320 Appendix_D_BenefitsPremiumsInformation
199276 Issuers Training and Communication Form and Instruction ModifiedCMS-10320 Appendix_C_InsuranceIssuers
199276 Issuers Training and Communication Form and Instruction ModifiedCMS-10320.Issuer - FINAL Instructions and Instruments
199275 States - Data Collection Form and Instruction ModifiedCMS-10320 Appendix_E_StateRequirements
199275 States - Data Collection Form and Instruction ModifiedCMS-10320.FINAL State Instructions and Instrument
192726 States - Training, reviewing regulation, and analyzing data Form and Instruction ModifiedCMS-10320 Appendix_E_StateRequirements
192726 States - Training, reviewing regulation, and analyzing data Form and Instruction ModifiedCMS-10320.FINAL State Instructions and Instrument (5-5-10).
192725 States - Data submission Form and Instruction ModifiedCMS-10320 Appendix_E_StateRequirements
192725 States - Data submission Form and Instruction ModifiedCMS-10320.FINAL State Instructions and Instrument (5-5-10).

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2016 36 Months From Approved
5,550 0 0
91,225 0 0
0 0 0





Reginfo record details
12
table that charts list of burden
IC Title Form No. Form Name
Issuer - Attest (Individual) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuer - Attest (Small Group) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuer - Data Entry (Individual) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuer - Data Entry (Small Group) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuer - Troubleshoot (Individual) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuer - Troubleshoot (Small Group) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuers - Submission Preparation (Individual) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuers - Submission Preparation (Small Group) CMS-10320, CMS-10320, CMS-10320 ,   ,  
Issuers Training and Communication CMS-10320, CMS-10320, CMS-10320 ,   ,  
States - Data submission CMS-10320, CMS-10320 ,  
States - Data Collection CMS-10320, CMS-10320 ,  
States - Training, reviewing regulation, and analyzing data CMS-10320, CMS-10320 ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,550 0 0 0 0 5,550
Annual Time Burden (Hours) 91,225 0 0 4,600 0 86,625
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No