Information Collection

Confirmations on the State EHB-benchmark Plan

IC 203740 under ICR 202311-0938-014 · OMB 0938-1174.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1174 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10448 Confirmations on the State EHB-benchmark Plan Form and Instruction
CMS-10448 EHB State Confirmations CMS-10448_Appendix_A_EHB_State_Confirmations_508.pdf Form and Instruction
CMS-10448 EHB State Confirmations CMS-10448_Appendix_A_EHB_State_Confirmations_508.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Confirmations on the State EHB-benchmark Plan	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 156.111(e)(1)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10448	EHB State Confirmations	CMS-10448_Appendix_A_EHB_State_Confirmations_508.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5	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: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5	-170	175
Annual IC Time Burden (Hours)	20	-68	88
Annual IC Cost Burden (Dollars)	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.