OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Health Insurance Cost Sharing Collection- 2020

IC 236893 under ICR 202209-0935-003 · OMB 0935-0118.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Health Insurance Cost Sharing Collection- 2020
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 107a Attachment 107a.Protocol A (Medicare) Attachment 107a.Protocol A (Medicare)_final OMB_v2.docx Yes Yes Fillable Fileable
Form and Instruction 107b Attachment 107b.Protocol B (Employer) Attachment 107b.Protocol B (Employer)_final OMB_v2.docx Yes Yes Fillable Fileable
Form and Instruction 107c Attachment 107c.Protocol C (Private with Medicare)_ Attachment 107c.Protocol C (Private with Medicare)_final OMB_v2.docx Yes Yes Fillable Fileable
Form and Instruction 107d Attachment 107d.Protocol D (Other) Attachment 107d.Protocol D (Other)_final OMB_v2.docx Yes Yes Fillable Fileable

Health Health Care Services

 

6,258 0
   
Individuals or Households
 
   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 8,135 0 0 0 0 8,135
Annual IC Time Burden (Hours) 6,101 0 0 0 0 6,101
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.