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Federal forms, ICRs, and supporting documents

Information Collection

Private Company for Disbursement of checks

IC 201983 under ICR 202311-0938-016 · OMB 0938-1164.

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

View Information Collection (IC)

Private Company for Disbursement of checks
 
No Modified
 
Mandatory
 
45 CFR 158

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10418 MLR Notice 1 - Individual Market to Subscribers MLR Notice 1 Individual Market- Rebate to Subsribers.pdf Yes Yes Fillable Printable
Form CMS-10418 MLR Notice 2 Group Markets - Rebate to Policyholder CMS-10418 - MLR-Notice-2-Group-Markets-Rebate-to-Policyholderf.docx Yes Yes Fillable Printable
Form CMS-10418 MLR Notice 3 - Group Markets - Rebate to Subscribers MLR Notice 3 Group Markets - Rebate to Subscribers.pdf Yes Yes Fillable Printable
Instruction 2022 MLR Form Instructions.pdf Yes Yes Paper Only
Form CMS-10418 MLR Notice Individual Market to Subscribers Optional B MLR Notice 1 Individual Market - to Subscribers Optional-B.pdf Yes Yes Fillable Printable

Health Health Care Services

 

62 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 994,046 0 0 -918,194 0 1,912,240
Annual IC Time Burden (Hours) 24,851 0 0 -22,956 0 47,807
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.