Proposed Annual Ongoing Costs Regarding Disclosure of Agent and Broker Compensation to Enrollees Prior to Enrollment

Agent and Broker Disclosure and Reporting Requirements (CMS-10787)

Documents and Forms

Document Name Document Type
CMS-10787 - Appendix 1 - Agent and Broker Disclosure and Reporting Requirements Data Elements.pdf Other-Data
CMS-10787 - Appendix 1 - Agent and Broker Disclosure and Reporting Requirements Data Elements.pdf Other-Data

Information Collection (IC) Details

IC Title:	Proposed Annual Ongoing Costs Regarding Disclosure of Agent and Broker Compensation to Enrollees Prior to Enrollment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 148.410(c)(2)(i)-(ii) 45 CFR 148.410(c)(3) 45 CFR 148.410(c)(4) 45 CFR 148.410(c)(5)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data			CMS-10787 - Appendix 1 - Agent and Broker Disclosure and Reporting Requirements Data Elements.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56,865	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: 100 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	1,166,361	1,166,361
Annual IC Time Burden (Hours)	30,419	30,419
Annual IC Cost Burden (Dollars)	333,246	333,246

Documents for IC

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.