Essential Health Benefits Benchmark Plans and Accrediting Entities Data Collection

Essential Health Benefits Benchmark Plans (CMS-10488)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form CMS-10488 Essential Health Benefits Benchmark Plans and Accrediting Entities Data Collection Form
CMS-10488 Data Collection Instructions CMS-10448 - Data Collection Instructions..docx Form
Appendix_B_EHB_Elements 08-14-2012.docx Appendix B - Benchmark Plan Data Requirements IC Document

Information Collection (IC) Details

IC Title:	Essential Health Benefits Benchmark Plans and Accrediting Entities Data Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 45 CFR 156.120

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10488	Data Collection Instructions	CMS-10448 - Data Collection Instructions..docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	51	-107	158
Annual IC Time Burden (Hours)	77	-555	632
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix B - Benchmark Plan Data Requirements	Appendix_B_EHB_Elements 08-14-2012.docx	08/15/2012

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