QHP Issuer Data Collection and Display

Information Collection for Transparency in Coverage Reporting by Qualified Health Plan Issuers (CMS-10572)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.