Basic Health Program Supporting Regulations

Basic Health Program Report for Health Insurance Exchange Premium (CMS-10510)

OMB: 0938-1218

IC ID: 209843

Information Collection (IC) Details

View Information Collection (IC)

Basic Health Program Supporting Regulations
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10510 Annual Report 2022 Annual Report Template for BHP Final (2022 version 4).docx Yes Yes Fillable Fileable
Form and Instruction CMS-10510 Blueprint Blueprint Template (2022 version 4).docx Yes Yes Fillable Fileable
Form and Instruction CMS-10510 State Report for Health Insurance Exchange Premiums State Report for Exchange Premiums (2022 version 2).xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-10510 Enrollment Data Guide 508EnrollDataGuideNov2015.pdf Yes Yes Fillable Fileable
Instruction Actual Enrollment Data Sample Spreadsheet.xlsx No   Printable Only

Health Health Care Services

Health Insurance Exchanges (HIX) Program  78 FR 63211

2 0
   
State, Local, and Tribal Governments
 
   100 %

  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 27 0 0 0 0 27
Annual IC Time Burden (Hours) 2,568 0 0 0 0 2,568
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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