Information Collection

Upload of Risk Adjustment and Reinsurance Data for Masked Enrollee Identification Number (153.700(a))

IC 208837 under ICR 201405-0938-006 · OMB 0938-1155.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1155 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Upload of Risk Adjustment and Reinsurance Data for Masked Enrollee Identification Number (153.700(a))	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 153.700(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

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	600	1,800
Annual IC Time Burden (Hours)	7,200	1,800	5,400
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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