Information Collection

Exchange Functions: Certification of Qualified Health Plans (§155.1000 through §155.1080)

IC 244021 under ICR 202009-0938-016 · OMB 0938-1312.

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Information Collection (IC) Details

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IC Title:	Exchange Functions: Certification of Qualified Health Plans (§155.1000 through §155.1080)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.1075 45 CFR 155.1080

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: 20	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 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	1,650	1,650
Annual IC Cost Burden (Dollars)	0	0

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