Reinsurance and Risk Adjustment

Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1187 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10433 Reinsurance and Risk Adjustment Form
CMS-10433 Banking and Edge Server D1 RI RA Banking and Edge Server.pdf Form

Information Collection (IC) Details

IC Title:	Reinsurance and Risk Adjustment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 153.220, 410, 540, 610

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10433	Banking and Edge Server	D1 RI RA Banking and Edge Server.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,400	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,400	1,800	600
Annual IC Time Burden (Hours)	15,200	11,400	3,800
Annual IC Cost Burden (Dollars)	0	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.