Product Renewal and Discontinuance Notice for QHP Issuers

Annual Eligibility Redetermination, Product Discontinuation and Renewal Notices (CMS-10527)

Documents and Forms

Document Name Document Type
Form CMS-10527 Product Renewal and Discontinuance Notice for QHP Issuers Form and Instruction
CMS-10527 Renewal and Discontinuance Notice CMS-10527 Attachment 2- Renewal Notice QHP 30 - day clean.pdf Form and Instruction
CMS-10527 Renewal and Discontinuance Notice CMS-10527 Attachment 2- Renewal Notice QHP 30-day rev.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Product Renewal and Discontinuance Notice for QHP Issuers	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 156.1255

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10527	Renewal and Discontinuance Notice	CMS-10527 Attachment 2- Renewal Notice QHP 30-day rev.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 333	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	333	89	244
Annual IC Time Burden (Hours)	7,992	2,136	5,856
Annual IC Cost Burden (Dollars)	0	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.