Product Discontinuance Notice for Issuers Outside the Marketplace (Non-QHP)

Annual Eligibility Redetermination, Product Discontinuation and Renewal Notices (CMS-10527)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1254 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10527 Product Discontinuance Notice for Issuers Outside the Marketplace (Non-QHP) Form and Instruction
CMS-10527 Discontinuation Notices CMS-10527 Appendix D - Renewal and Discontinuation Notices - Small Group.pdf Form and Instruction
CMS-10527 Federal Standard Notices CMS-10527 Appendix C - Updated-Federal-Standard-Notices.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Product Discontinuance Notice for Issuers Outside the Marketplace (Non-QHP)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 147.106 45 CFR 146.152 45 CFR 148.122

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10527	Discontinuation Notices	CMS-10527 Appendix D - Renewal and Discontinuation Notices - Small Group.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10527	Federal Standard Notices	CMS-10527 Appendix C - Updated-Federal-Standard-Notices.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,805	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,185	-1,755	5,940
Annual IC Time Burden (Hours)	30,877	-17,593	48,470
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.