Proposed Annual Ongoing Costs Regarding Issuer Reporting of Agent and Broker Compe nsation to HHS

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 Issuer Reporting of Agent and Broker Compe nsation to HHS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 148.410(d)

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: 1,324	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	1,324	1,324
Annual IC Time Burden (Hours)	66,200	66,200
Annual IC Cost Burden (Dollars)	0	0

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.