Third Party Payment Notification

Third Party Payment of QHP Premiums and Additional Notices for QHP Issuers Data Collection (CMS-10595)

OMB: 0938-1301

IC ID: 219318

Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details

View Information Collection (IC)

Third Party Payment Notification
 
No Removed
 
Required to Obtain or Retain Benefits
 
45 CFR 156.156(f)

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

Health Health Care Services

 

500 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 0 500 0 -500 0 0
Annual IC Time Burden (Hours) 0 2,000 0 -2,000 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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