Reporting Templates

The Health Insurance Enforcement and Consumer Protections Grant Program (CMS-10605)

Documents and Forms

Document Name Document Type
Form CMS-10605 Reporting Templates Form and Instruction
CMS-10605 Annual Report Template CMS-10605 - The Enforcement and Consumer Protections Cycle I Annual Report Template ....pdf Form and Instruction
CMS-10605 Quarterly Report Template CMS-10605 - The Enforcement and Consumer Protections Cycle I Quarterly Report Templa....pdf Form and Instruction
CMS-10605 Final Report CMS-10605 - The Enforcement and Consumer Protections Cycle I Final Report Template ....pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Reporting Templates	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10605	Annual Report Template	CMS-10605 - The Enforcement and Consumer Protections Cycle I Annual Report Template ....pdf	Yes	No	Fillable Fileable
Form and Instruction	CMS-10605	Quarterly Report Template	CMS-10605 - The Enforcement and Consumer Protections Cycle I Quarterly Report Templa....pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10605	Final Report	CMS-10605 - The Enforcement and Consumer Protections Cycle I Final Report Template ....pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 23	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	115	115
Annual IC Time Burden (Hours)	2,898	2,898
Annual IC Cost Burden (Dollars)	0	0

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.