Information Collection

DE Entity Web-brokers and QHP Issuers to Implement Mandate for HealthCare.gov website Changes

IC 263474 under ICR 202311-0938-002 · OMB 0938-1463.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1463 can be found here:

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Information Collection (IC) Details

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IC Title:	DE Entity Web-brokers and QHP Issuers to Implement Mandate for HealthCare.gov website Changes	Agency IC Tracking Number:	CCIIO - 10877

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.221(b)(6)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 125	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 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	125	125
Annual IC Time Burden (Hours)	3,075	3,075
Annual IC Cost Burden (Dollars)	245,290	245,290

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.