Information Collection Request

Information Collection for Machine Readable Data for Provider Network and Prescription Formulary Content for FFM QHPs

ICR 201506-0938-017 · OMB 0938-1284 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10558 QHP Network and Formulary - Developer Documentation Form and Instruction New Available
CMS-10558 - Machine Readable 30 Day Public Comment Tracking Tool 09282015.pdf Supplementary Document Uploaded 2015-09-29 Available
CMS-10558 Crosswalk.xlsx Supplementary Document Uploaded 2015-06-29 Available
CMS-10558 - Response to comment document.pdf - Adobe Acrobat Pro.pdf Supplementary Document Uploaded 2015-06-29 Available
CMS-10558 Machine Readable Data SS 9292015.pdf Supporting Statement A Uploaded 2015-09-29 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
217257 QHP Network and Formulary - Developer Documentation Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2017 36 Months From Approved
5,700 0 0
98,800 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
QHP Network and Formulary - Developer Documentation CMS-10558 QHP Network and Formulary - Developer Documentation

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,700 0 0 5,700 0 0
Annual Time Burden (Hours) 98,800 0 0 98,800 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No