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Federal forms, ICRs, and supporting documents

Information Collection

Basic Health Program Supporting Regulations

IC 209843 under ICR 202311-0938-008 · OMB 0938-1218.

Documents and Forms
Document Name
Document Type
Form and Instruction
Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Basic Health Program Supporting Regulations
 
No Modified
 
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 %

  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 47 0 20 0 0 27
Annual IC Time Burden (Hours) 3,172 0 604 0 0 2,568
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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