Information Collection

QHP Issuer Data Collection and Display

IC 221316 under ICR 201903-0938-009 · OMB 0938-1310.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1310 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10572 QHP Issuer Data Collection and Display	Form
CMS-10572 QHP Issuer Data Collection and Display CMS-10572-Transparency PRA Appendix A_Final_508.pdf	Form
CMS-10572 Data Submission Template CMS-10572-Transparency PRA Appendix C_Data submission_Template_508.pdf	Form and Instruction

IC Title:

QHP Issuer Data Collection and Display

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 156.220

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
Form	CMS-10572	QHP Issuer Data Collection and Display	CMS-10572-Transparency PRA Appendix A_Final_508.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10572	Data Submission Template	CMS-10572-Transparency PRA Appendix C_Data submission_Template_508.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 470

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	470	-5	475
Annual IC Time Burden (Hours)	42	-30	72
Annual IC Cost Burden (Dollars)	0	0	0

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.