Differential Display of Standardized Options on the Web Sites of Agents and Brokers and QHP Issuers

Information Collection Requirements for Non-Exchange Entities (CMS-10666)

Documents and Forms

Document Name Document Type
Appendix A - Agents and Brokers_.docx Instruction
Appendix A - Agents and Brokers_.docx Instruction

Information Collection (IC) Details

IC Title:	Differential Display of Standardized Options on the Web Sites of Agents and Brokers and QHP Issuers	Agency IC Tracking Number:	CMS-10666

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 156.265 45 CFR 155.220

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Appendix A - Agents and Brokers_.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 110	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	110	110
Annual IC Time Burden (Hours)	220	220
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.