QHP Network and Formulary - Developer Documentation

Information Collection for Machine Readable Data for Provider Network and Prescription Formulary Content for FFM QHPs (CMS-10558)

OMB: 0938-1284

IC ID: 217257

Information Collection (IC) Details

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QHP Network and Formulary - Developer Documentation
 
No Modified
 
Mandatory
 
45 CFR 156.122(d)(1)(2) 45 CFR 156.230(c)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10558 QHP Provider Formulary CMS-10558-Machine Readable Appendix A-508.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

376 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,512 0 0 -252 0 4,764
Annual IC Time Burden (Hours) 31,484 0 0 -51,092 0 82,576
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Appendix B CMS-10558-Machine Readable Appendix B-508.pdf 11/27/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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