Enrollment of Employees into QHPs under SHOP

Small Business Health Options Program (SHOP) Effective Date and Termination Notice Requirements (CMS-10555)

OMB: 0938-1303

IC ID: 219290

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Enrollment of Employees into QHPs under SHOP
 
No New
 
Required to Obtain or Retain Benefits
 
45 CFR 155.720

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

445 0
   
Private Sector Businesses or other for-profits
 
   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 445 445 0 0 0 0
Annual IC Time Burden (Hours) 15,575 15,575 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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