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EHB Reporting - EHB Actuarial Certificate Template
Essential Health Benefits Benchmark Plans (CMS-10448)
OMB: 0938-1174
IC ID: 229047
OMB.report
HHS/CMS
OMB 0938-1174
ICR 202408-0938-009
IC 229047
( )
Documents and Forms
Document Name
Document Type
Form CMS-10488
EHB Reporting - EHB Actuarial Certificate Template
Form and Instruction
CMS-10488 EHB Confirmation Template
CMS-10448_Appendix_A_EHB_State_Confirmations_508.pdf
Form and Instruction
CMS-10448 EHB Benchmark Plan Certification
CMS-10448_Appendix_B_EHB_Benchmark_Plan_Certificate_508.pdf
Form and Instruction
CMS-10448 Benchmark Plans Prescription Template
CMS-10448_Appendix_D_EHB_Benchmark_Plan_Rx_508.pdf
Form and Instruction
CMS-10448 Summary of Benefits Template
CMS-10448_Appendix_C_EHB_Summary_Benefits_508.pdf
Form and Instruction
CMS-10448 EHB Benchmark Plan Certificate
CMS-10448_Appendix_B_EHB_Benchmark_Plan_Certificate_508.pdf
Form and Instruction
CMS-10448_ Appendix E EHB BM Plans 2019_EHB Chart.pdf
Appendix E - Benchmark Plans 2019 EHB Chart - Information Only
IC Document
Information Collection (IC) Details
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