EHB Dental Plan Issuers

Essential Health Benefits Benchmark Plans

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1174 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10448 EHB Dental Plan Issuers Form and Instruction
CMS-10448 Notice of Intent to Provide Dental Coverage in the Excha 508Appendix_C-4_EHB Draft Dental NOI 20120516.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	EHB Dental Plan Issuers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 156.120

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10448	Notice of Intent to Provide Dental Coverage in the Exchange	508Appendix_C-4_EHB Draft Dental NOI 20120516.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	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: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	10	10
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.