Good Cause Processes (Sec. 417.460, 422.74, and 423.44)

Good Cause Processes (CMS-10544)

Documents and Forms

Document Name Document Type
Good_Cause_Section_60.3.4.1_Chapter 2_MMCM _incl_Exhibits.pdf 60.3.4.1- Process for Good Cause Determinations for Nonpayment of Plan Premiums IC Document

Information Collection (IC) Details

IC Title:	Good Cause Processes (Sec. 417.460, 422.74, and 423.44)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 417.460 42 CFR 422.74 42 CFR 423.44

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 41,289	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	41,289	31,281	10,008
Annual IC Time Burden (Hours)	27,499	20,834	6,665
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
60.3.4.1- Process for Good Cause Determinations for Nonpayment of Plan Premiums	Good_Cause_Section_60.3.4.1_Chapter 2_MMCM _incl_Exhibits.pdf	11/02/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.