Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)

Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment (CMS-10492)

OMB: 0938-1285

IC ID: 217425

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

View Information Collection (IC)

Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 156.50(d)(2)(i)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10492 Notice of Availability of Separate Contraception Payments from Fully Insured Issuers CMS-10492 - Issuer and TPA data elements for FFE adjustment.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

205 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested 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 205 0 0 0 0 205
Annual IC Time Burden (Hours) 120 0 0 0 0 120
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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