EHB Benchmark Plan Formulary Drug

Essential Health Benefits Benchmark Plans (CMS-10448)

OMB: 0938-1174

IC ID: 241291

Information Collection (IC) Details

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EHB Benchmark Plan Formulary Drug
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 156.111(e)(3)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10448 EHB Benchmark Rx Plan CMS-10448_Appendix_D_EHB_Benchmark_Plan_Rx_508.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

5 0
   
State, Local, and Tribal Governments
 
   0 %

  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 5 0 0 -36 0 41
Annual IC Time Burden (Hours) 60 0 0 41 0 19
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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