Information Collection

Risk Corridors Transitional Policy

IC 214480 under ICR 201501-0938-001 · OMB 0938-1267.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10532 Risk Corridors Transitional Policy	Form
CMS-10532 - Transitional Adjustment Reporting Form Instructions (Final) Jan clean.pdf	Instruction
CMS-10532 Transitional Policy Reporting Form CMS-10532 Copy of 30 day transitional reporting form_Jan clean v2.xlsx	Form
CMS-10532 Memo regarding change to transitional form.docx Modifications to the Updated Version of Transitional Adjustment Data Reporting Form	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 153.530

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10532	Transitional Policy Reporting Form	CMS-10532 Copy of 30 day transitional reporting form_Jan clean v2.xlsx		Yes	Yes	Fillable Fileable
Instruction			CMS-10532 - Transitional Adjustment Reporting Form Instructions (Final) Jan clean.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 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: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Modifications to the Updated Version of Transitional Adjustment Data Reporting Form	CMS-10532 Memo regarding change to transitional form.docx	02/09/2015

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