Direct Enrollment Entity Separate Plan Display Exception Requirement

Supporting Statement for Direct Enrollment Entities (CMS-10877)

OMB: 0938-1463

IC ID: 263333

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Direct Enrollment Entity Separate Plan Display Exception Requirement CCIIO - 10877
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
45 CFR 155.221(c)(1)-(2)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

20 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 20 20 0 0 0 0
Annual IC Time Burden (Hours) 400 400 0 0 0 0
Annual IC Cost Burden (Dollars) 32,016 32,016 0 0 0 0

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