Mandatory Insurer Reporting (GHP-Private, Maintenance/Administrative)

Mandatory Insurer Reporting Requirements of Section 111 of the Medicare, Medicaid and SCHIP Act of 2007 (CMS-10265)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1074 can be found here:

Documents and Forms

Document Name Document Type
CMS-10265.GHPUserGuide121708 (GHP-Private, Maintenance & Administrative).pdf Instruction

Information Collection (IC) Details

IC Title:	Mandatory Insurer Reporting (GHP-Private, Maintenance/Administrative)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-10265.GHPUserGuide121708 (GHP-Private, Maintenance & Administrative).pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Medicare Advantage Prescription Drug System (MARx)	FR Citation: 70 FR 60530

Number of Respondents: 1,134	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,134	-416	1,550
Annual IC Time Burden (Hours)	24,948	21,848	3,100
Annual IC Cost Burden (Dollars)	0	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.