Incident Reporting

State Health Insurance Exchange Security Incident Report

OMB: 0938-1216

IC ID: 208397

Information Collection (IC) Details

View Information Collection (IC)

Incident Reporting
 
No New
 
Mandatory
 
45 CFR 155.260

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10496 STATE HEALTH INSURANCE EXCHANGE SECURITY INCIDENT REPORT CMS-10496_HIM_State_Incident_Report-508.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

18 0
   
State, Local, and Tribal Governments
 
   0 %

  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 936 936 0 0 0 0
Annual IC Time Burden (Hours) 234 234 0 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.

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