Information Collection

EHB Dental Plan Issuers

IC 203740 under ICR 201502-0938-010 · OMB 0938-1174.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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: 175

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	175	155	20
Annual IC Time Burden (Hours)	88	78	10
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.