Issuers - Submission Preparation (Small Group)

Health Care Reform Insurance Web Portal Requirements 45 CFR part 159 (CMS-10320)

Documents and Forms

Document Name Document Type
Form CMS-10320 Issuers - Submission Preparation (Small Group) Form and Instruction
CMS 10320 Appendix C Issuer and Product Level Data_PRA 2020.pdf Instruction
CMS 10320 Appendix C Issuer and Product Level Data_PRA 2020.pdf Instruction
CMS 10320 Appendix D_Data Collection_PRA2020.pdf Instruction
CMS 10320 Appendix D_Data Collection_PRA2020.pdf Instruction
CMS-10320 Issuer Instructions and Instruments CMS-10320 Issuer - FINAL Instructions and Instruments.pdf Form and Instruction
CMS-10320 Issuer Instructions and Instruments CMS-10320 Issuer - FINAL Instructions and Instruments.pdf Form and Instruction
CMS 10320 Appendix G_2020 .xlsm Data Collection Template IC Document
CMS 10320 Appendix G_2020 .xlsm Data Collection Template IC Document

Information Collection (IC) Details

IC Title:	Issuers - Submission Preparation (Small Group)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10320	Issuer Instructions and Instruments	CMS-10320 Issuer - FINAL Instructions and Instruments.pdf	Yes	Yes	Fillable Fileable
Instruction			CMS 10320 Appendix C Issuer and Product Level Data_PRA 2020.pdf	Yes	Yes	Paper Only
Instruction			CMS 10320 Appendix D_Data Collection_PRA2020.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	500	-200	700
Annual IC Time Burden (Hours)	26,000	-4,800	30,800
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Data Collection Template	CMS 10320 Appendix G_2020 .xlsm	01/28/2022

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