Information Collection

Notice of rebates to Subscribers and Policyholders

IC 201982 under ICR 202311-0938-016 · OMB 0938-1164.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
MLR Notice 1 Individual Market- Rebate to Subsribers.pdf	Other-Template
MLR Notice 1 Individual Market- Rebate to Subsribers.pdf	Other-Template
MLR Notice 2 Group Markets - Rebate to Policyholder.pdf	Other-Template
MLR Notice 2 Group Markets - Rebate to Policyholder.pdf	Other-Template
MLR Notice 3 Group Markets - Rebate to Subscribers.pdf	Other-Template
MLR Notice 3 Group Markets - Rebate to Subscribers.pdf	Other-Template

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 158

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Template	MLR Notice 1 Individual Market- Rebate to Subsribers.pdf	Yes	No	Paper Only
Other-Template	MLR Notice 2 Group Markets - Rebate to Policyholder.pdf	Yes	No	Printable Only
Other-Template	MLR Notice 3 Group Markets - Rebate to Subscribers.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 114

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 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,200,368	-3,050,444	7,250,812
Annual IC Time Burden (Hours)	38,824	-26,281	65,105
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.