Product Discontinuance Notice for Issuers Outside the Marketplace (Non-QHP)

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

OMB: 0938-1254

IC ID: 212940

Information Collection (IC) Details

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Product Discontinuance Notice for Issuers Outside the Marketplace (Non-QHP)
 
No Modified
 
Mandatory
 
45 CFR 146.152 45 CFR 148.122 45 CFR 147.106

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10527 Discontinuation Notices CMS-10527 Attachment 3 - Discontinuation Notice with auto enrollment Off Exchange 30 -day.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10527 Federal Standard Notices CMS-10527 Attachment 5 - Discontinuation Notice without auto enrollment Off Exchange 30 - day.pdf Yes Yes Paper Only

Health Health Care Services

 

1,340 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 3,047 0 0 -1,138 0 4,185
Annual IC Time Burden (Hours) 22,481 0 0 -8,396 0 30,877
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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