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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
OMB.report
HHS/CMS
OMB 0938-1254
ICR 202304-0938-018
IC 212940
( )
Documents and Forms
Document Name
Document Type
Form CMS-10527
Product Discontinuance Notice for Issuers Outside the Marketplace (Non-QHP)
Form and Instruction
CMS-10527 Discontinuation Notices
CMS-10527 Attachment 3 - Discontinuation Notice with auto enrollment Off Exchange 30 -day.pdf
Form and Instruction
CMS-10527 Discontinuation Notices
CMS-10527 Attachment 3 - Discontinuation Notice with auto enrollment Off Exchange 30 -day.pdf
Form and Instruction
CMS-10527 Federal Standard Notices
CMS-10527 Attachment 5 - Discontinuation Notice without auto enrollment Off Exchange 30 - day.pdf
Form and Instruction
CMS-10527 Federal Standard Notices
CMS-10527 Attachment 5 - Discontinuation Notice without auto enrollment Off Exchange 30 - day.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Product Discontinuance Notice for Issuers Outside the Marketplace (Non-QHP)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
45 CFR 146.152
45 CFR 148.122
45 CFR 147.106
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
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
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,340
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
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
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.