Information Collection

Issuer Reporting Requirements for Selecting a Cost-Sharing Reductions Reconciliation Methodology

IC 207593 under ICR 201608-0938-012 · OMB 0938-1214.

Documents and Forms

Document Name Document Type
CMS-10469 CSR Recon PRA Appendix A (extension) (04 28 16).docx Other-Appendix

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Issuer Reporting Requirements for Selecting a Cost-Sharing Reductions Reconciliation Methodology	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 48 CFR 156.430(c)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix			CMS-10469 CSR Recon PRA Appendix A (extension) (04 28 16).docx		No		Paper Only

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	575	-625	1,200
Annual IC Time Burden (Hours)	6,325	-6,875	13,200
Annual IC Cost Burden (Dollars)	6,325	-6,875	13,200

Documents for IC

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