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Federal forms, ICRs, and supporting documents

Information Collection

Information Collection Requirements for Compliance with Individual and Group Market Reforms under Title XXVII of the Public Health Service Act

IC 43664 under ICR 202508-0938-011 · OMB 0938-0702.

Documents and Forms
Document Name
Document Type
Other-Notice
Other-Notice
Other-Notice
Other-Notice
Other-Notice
Other-Notice
Other-Notice
Other-Notice
Information Collection (IC) Details

View Information Collection (IC)

Information Collection Requirements for Compliance with Individual and Group Market Reforms under Title XXVII of the Public Health Service Act
 
No Modified
 
Mandatory
 
45 CFR 146.150 45 CFR 146.111 45 CFR 146.152 45 CFR 146.180 45 CFR 146.160 45 CFR 146.115 45 CFR 146.117

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Notice CMS-10430_Model_Notice_to_Enrollees_ENGLISH.docx Yes No Paper Only
Other-Notice CMS-10430_Model_Notice_to_Enrollees_ARABIC.docx Yes No Paper Only
Other-Notice CMS-10430_Model_Notice_to_Enrollees_FRENCH.docx Yes No Paper Only
Other-Notice CMS-10430_Model_Notice_to_Enrollees_KOREAN.docx Yes No Paper Only
Other-Notice CMS-10430_Model_Notice_to_Enrollees_SPANISH.docx Yes No Paper Only
Other-Notice CMS-10430_Model_Notice_to_Enrollees_TAGALOG.docx Yes No Paper Only
Other-Notice CMS-10430_Model_Notice_to_Enrollees_TCHINESE.docx Yes No Paper Only
Other-Notice CMS-10430_Model_Notice_to_Enrollees_VIETNAMESE.docx Yes No Paper Only

Health Health Care Services

 

587 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested 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 12,891 0 0 -38,494 0 51,385
Annual IC Time Burden (Hours) 2,408 0 0 622 0 1,786
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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