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

Documents and forms in this information collection
Document Name	Document Type
CMS-10469 CSR Recon PRA Appendix A (extension) (04 28 16).docx	Other-Appendix

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.