Information Collection Request

Information Collection for Machine Readable Data for Provider Network and Prescription Formulary Content for FFM QHPs (CMS-10558)

ICR 201708-0938-016 · OMB 0938-1284 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10558 QHP Network and Formulary - Developer Documentation Form and Instruction Modified Available
CMS-10558 Machine Readable Supporting Statement_final.docx Supporting Statement A Uploaded 2017-08-23 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
217257 QHP Network and Formulary - Developer Documentation Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2020 36 Months From Approved 11/30/2017
4,764 0 5,700
82,576 0 98,800
0 0 0





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1
table that charts list of burden
IC Title Form No. Form Name
QHP Network and Formulary - Developer Documentation CMS-10558 QHP Provider Formulary

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,764 5,700 0 0 -936 0
Annual Time Burden (Hours) 82,576 98,800 0 0 -16,224 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No