Information Collection Request
Essential Health Benefits Benchmark Plans (CMS-10448)
ICR 202408-0938-009 · OMB 0938-1174 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10448 EHB Benchmark Plan Formulary Drug |
Form and Instruction | Modified | Available |
| Form CMS-10448 State's EHB-benchmark Plan's Benefits and Limits |
Form and Instruction | Modified | Repair queued |
| Form CMS-10488 EHB Reporting - EHB Actuarial Certificate Template |
Form and Instruction | Modified | Repair queued |
| Form CMS-10448 Confirmations on the State EHB-benchmark Plan |
Form and Instruction | Modified | Missing upstream |
 CMS-10448 EHB Substantive Supporting Statement.docx |
Supporting Statement A | Uploaded 2024-08-08 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 241291 |  EHB Benchmark Plan Formulary Drug |
Form and Instruction | Modified | |
| 231104 | State's EHB-benchmark Plan's Benefits and Limits |
Form and Instruction | Modified | |
| 229047 | EHB Reporting - EHB Actuarial Certificate Template |
Form and Instruction | Modified | |
| 203740 | Confirmations on the State EHB-benchmark Plan |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1174 |
| Type of Information Collection | Reinstatement with change of a previously approved collection |
| Previous ICR Reference No | 202311-0938-014 |
| Agency Tracking No | CCIIO |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |