Grandfathered Plan Change in Carrier Disclosure

Disclosure and Recordkeeping Requirements for Grandfathered Health Plans under the Affordable Care Act (CMS-10325)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1093 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	Grandfathered Plan Change in Carrier Disclosure	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 147.140

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,424	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	Previously Approved
Annual Number of Responses for this IC	3,424	-4,016	7,440
Annual IC Time Burden (Hours)	114	-132	246
Annual IC Cost Burden (Dollars)	3,424	-4,016	7,440

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.