Information Collection Request

Establishment of Qualified Health Plans and American Health Benefit Exchanges (CMS-10400)

ICR 202406-0938-009 · OMB 0938-1156 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CMS-10400 Exchange Rule Supporting Statement.docx Supporting Statement A Uploaded 2024-06-17 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
220456 QHP Issuers Developing Segregation Plans Modified
198557 Submission of Issuer Attestation Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2027 36 Months From Approved 09/30/2024
1,617 0 210
5,509 0 580
0 0 0





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2
table that charts list of burden
IC Title Form No. Form Name
QHP Issuers Developing Segregation Plans
Submission of Issuer Attestation

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,617 210 0 0 1,407 0
Annual Time Burden (Hours) 5,509 580 0 0 4,929 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No