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Federal forms, ICRs, and supporting documents

Information Collection

Health Insurance Issuer Submission of the Preliminary Justification

IC 198019 under ICR 202408-0938-033 · OMB 0938-1141.

Documents and Forms
Document Name
Document Type
Other-Microsoft Word
Other-Microsoft Word
Instruction
Instruction
Information Collection (IC) Details

View Information Collection (IC)

Health Insurance Issuer Submission of the Preliminary Justification CMS-10379
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Microsoft Word CMS-10379 - Unified_Rate_Review_Template v6.0 - 08-08-24.xlsm Yes No Printable Only
Instruction 2024 PY URR instructions clean - 8-8-24.docx Yes No Paper Only

Health Health Care Services

 

573 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 573 0 -16 0 589 0
Annual IC Time Burden (Hours) 17,533 0 -2,706 0 20,239 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.