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

Issuer Reporting Requirements for Selecting a Cost-Sharing Reductions Reconciliation Methodology (CMS-10469)

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

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
No associated records found

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