Information Collection Request
Essential Health Benefits Benchmark Plans (CMS-10448)
ICR 202311-0938-014 · OMB 0938-1174 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1174 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10448 EHB Benchmark Plan Formulary Drug |
Form and Instruction | Modified | Missing upstream |
| Form CMS-10448 State's EHB-benchmark Plan's Benefits and Limits |
Form and Instruction | Modified | Repair queued |
| Form CMS-10488 EHB Reporting - EHB Actuarial Certificate Template |
Form and Instruction | Modified | Missing upstream |
| Form CMS-10448 Confirmations on the State EHB-benchmark Plan |
Form and Instruction | Modified | Repair queued |
 CMS-10448_EHB_Substantive_Supporting_Statement_508.docx |
Supporting Statement A | Uploaded 2024-02-12 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 241291 |  EHB Benchmark Plan Formulary Drug |
Form and Instruction | Modified | |
| 231104 | State's EHB-benchmark Plan's Benefits and Limits |
Form and Instruction | Modified | |
| 229047 | EHB Reporting - EHB Actuarial Certificate Template |
Form and Instruction | Modified | |
| 203740 | Confirmations on the State EHB-benchmark Plan |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1174 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202006-0938-008 |
| Agency Tracking No | CCIIO |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |