Information Collection

Patient safety reporting standards for QHP issuers

IC 212995 under ICR 201603-0938-008 · OMB 0938-1249.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	Patient safety reporting standards for QHP issuers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 45 CFR 156.1120-1125 45 CFR 156.200(b)(5) 45 CFR 156.1110 45 CFR 155.200(d) 45 CFR 156.1105

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 575	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: 0 %

	Approved	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	575	0	575
Annual IC Time Burden (Hours)	1,750	600	1,150
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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