Health Insurance Issuer Submission of the Preliminary Justification

Rate Increase Disclosure and Review Reporting Requirements (CMS-10379)

OMB: 0938-1141

IC ID: 198019

Documents and Forms
Information Collection (IC) Details

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Health Insurance Issuer Submission of the Preliminary Justification CMS-10379
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Microsoft Word Preliminary Justification Submission Function.docx Yes No Printable Only
Instruction Revised 2017 Unified Rate Review Instructions clean 8.9.16.docx Yes No Paper Only

Health Health Care Services

 

3,243 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 3,665 0 0 -3,985 0 7,650
Annual IC Time Burden (Hours) 41,213 0 0 -42,937 0 84,150
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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