Information Collection Request

Information Collection for Transparency in Coverage Reporting by Qualified Health Plan Issuers (CMS-10572)

ICR 202111-0938-008 · OMB 0938-1310 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10572 Annual Submission of Transparency in Coverage Data Form and Instruction Modified Missing upstream
CMS-10572_Transparency in Coverage_Supporting Statement-508.docx Supporting Statement A Uploaded 2021-11-12 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
221316 Annual Submission of Transparency in Coverage Data Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 04/30/2022
360 470
51,480 42
0 0





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table that charts list of burden
IC Title Form No. Form Name
Annual Submission of Transparency in Coverage Data CMS-10572, CMS-10572 , CMS-10572, CMS-10572, CMS-10572, CMS-10572 QHP Issuer Data Collection - Appendix A2 ,   Data Submission Template - Appendix C ,   Data Elements - Appendix A1 ,   Data Templates Appendix B ,   Data Template Appendix B2 ,   Data Template - Appendix D

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 360 470 0 0 -110 0
Annual Time Burden (Hours) 51,480 42 0 1,178 50,260 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
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