Disclosure of State Rating Requirements

Disclosure of State Rating Requirements and Individual Market Special Enrollment Notice (CMS-10454)

OMB: 0938-1258

IC ID: 208568

Information Collection (IC) Details

View Information Collection (IC)

Disclosure of State Rating Requirements
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 147.102

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10454 State Rating Requirements Disclosure Form CMS-10454 - State Rating Requirements Disclosure Form 2016.docx Yes Yes Fillable Fileable

Health Health Care Services

 

48 0
   
State, Local, and Tribal Governments
 
   0 %

  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 432 0 0 0 0 432
Annual IC Time Burden (Hours) 2,084 0 0 0 0 2,084
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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