Information Collection

Patient safety reporting standards for QHP issuers

IC 212995 under ICR 202005-0938-012 · OMB 0938-1249.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1249 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Patient safety reporting standards for QHP issuers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 45 CFR 156.1120-1125 45 CFR 156.200(b)(5) 45 CFR 156.1110 45 CFR 155.200(d) 45 CFR 156.1105

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: 250	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.