OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Survey of Plan Sponsors (Public Entities)

IC 200145 under ICR 201301-0938-008 · OMB 0938-1150.

Documents and Forms
Document Name
Document Type
Form
Instruction
Instruction
Other-CMS-10408 ERRP Survey_Email to
Instruction
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Survey of Plan Sponsors (Public Entities)
 
No Modified
 
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 ERRP Survey of Plan Sponsors CMS 10408_ERRP Survey of Plan Sponsors_508.pdf Yes Yes Fillable Fileable
Instruction CMS 10408_ERRP Survey of Plan Sponsors_Instructions_508.pdf Yes No Printable Only
Form CMS-10408 REVISED ERRP Survey of Plan Sponsors 11-17-11 CMS-10408 REVISED ERRP Survey of Plan Sponsors 11-17-11 (2).docx Yes Yes Fillable Fileable
Instruction CMS-10408 REVISED _ ERRP Survey of Plan Sponsors _ Instructions 11-17-11.docx Yes No Printable Only
Other-CMS-10408 ERRP Survey_Email to Sponsors 11_17_11_FINAL CMS-10408 ERRP Survey_Email to Sponsors 11_17_11_FINAL.docx Yes No Printable Only
Instruction CMS-10408.Final Draft Survey Instructions (11-23-11).pdf Yes No Printable Only
Form CMS-10408 Final Survey CMS-10408.FINAL - Survey (11-28-11).pdf Yes No Fillable Printable

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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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.