Information Collection

Mandatory Insurer Reporting (GHP-Private)

IC 188574 under ICR 202011-0938-013 · OMB 0938-1074.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
4 GHP User Guide v5.pdf	Instruction
4 GHP User Guide v5.pdf	Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction					Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Medicare Advantage Prescription Drug System (MARx)

FR Citation: 70 FR 60530

Number of Respondents: 1,030

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,600,000	-1,000,000	2,600,000
Annual IC Time Burden (Hours)	133,333	-83,325	216,658
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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