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Grandfathered Plan Change in Carrier Disclosure
Disclosure and Recordkeeping Requirements for Grandfathered Health Plans under the Affordable Care Act (CMS-10325)
OMB: 0938-1093
IC ID: 195310
OMB.report
HHS/CMS
OMB 0938-1093
ICR 202204-0938-006
IC 195310
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Grandfathered Plan Change in Carrier Disclosure
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
45 CFR 147.140
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,190
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
1,190
0
0
-2,234
0
3,424
Annual IC Time Burden (Hours)
40
0
0
-74
0
114
Annual IC Cost Burden (Dollars)
1,541
0
0
-1,883
0
3,424
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.