Issuer - Attest (Individual)

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

OMB: 0938-1086

IC ID: 199283

Documents and Forms
Document Name
Document Type
Form and Instruction
Instruction
Instruction
Instruction
Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Issuer - Attest (Individual)
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10320 CMS-1032 - .Issuer - FINAL Instructions and Instruments CMS-10320 Issuer - FINAL Instructions and Instruments.pdf Yes Yes Fillable Fileable
Instruction CMS-10320 - Appendix C Insurance Issuer and Product Level Data.pdf Yes Yes Fillable Fileable
Instruction CMS-10320 Appendix D_Data Collection 2017.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

450 0
   
Private Sector Businesses or other for-profits
 
   100 %

  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 450 0 0 0 0 450
Annual IC Time Burden (Hours) 225 0 0 -675 0 900
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
© 2024 OMB.report | Privacy Policy