Appendix B - Issuer Details MPMS Screenshots

Appendix B. Machine Readable Issuer Details MPMS

OMB Control #: 0938-1284
Expiration Date: XX/XX/20XX

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 0938-1284. The information collection included in this
package reflects the time and effort to produce certain data to CMS in a machine-readable format to increase and enhance transparency of QHP
drug formulary information and of information about providers under health plans. The time required to complete this information collection is
estimated to average less than 136 hours per response for new QHP issuers and 64 hours per response for new SADP issuers in the first year, and
36 hours for returning QHP issuers and 18 hours for returning SADP issuers in the first year, which includes the time to review instructions, search
existing data resources, gather the data needed, to review and complete the information collection. This information collection, pursuant to 45
C.F.R. § 156.122(d), requires QHP issuers, including Small Business Health Options Program (SHOP) issuers but excluding stand-alone dental plans
(SADP) issuers, to publish an up-to-date, accurate, and complete list of all covered drugs, known as formularies. All information collected will
maintain consumer privacy with respect to the information disclosed to the extent of the applicable law and HHS policies. If you have comments
concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Mail Stop
C4-26-05, Baltimore, Maryland 21244-1850, Attention: Information Collections Clearance Officer or email Ana Alza at [email protected].

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Appendix B. Machine Readable Issuer Details MPMS

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