Minimum Essential Coverage Certification

Minimum Essential Coverage

OMB: 0938-1189

IC ID: 205752

Information Collection (IC) Details

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Minimum Essential Coverage Certification
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 156.304(a)(3) 45 CFR 156.604(d)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10465 Minimum Essential Coverage Certification (optional Excel file) CMS-10465 - MEC Application - Applicant and plan information.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10465 Minimum Essential Coverage Certification CMS-10465 - MEC - 30-Day Certification.pdf Yes Yes Fillable Printable

Health Health Care Services

 

10 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 10 0 0 0 0 10
Annual IC Time Burden (Hours) 53 0 0 0 0 53
Annual IC Cost Burden (Dollars) 2,200 0 0 0 0 2,200

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