Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)

Data Submission for the Federally-facilitated Exchange User Fee Adjustment (CMS-10492)

OMB: 0938-1285

IC ID: 217425

Information Collection (IC) Details

View Information Collection (IC)

Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)
 
No New
 
Required to Obtain or Retain Benefits
 
45 CFR 156.50(d)(2)(i)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10492 Notice of Availability of Separate Contraception Payments from Fully Insured Issuers CMS-10492 - Issuer and TPA data elements for FFE adjustment.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

325 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 325 325 0 0 0 0
Annual IC Time Burden (Hours) 406 406 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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