Information Collection

Annual Submission of Transparency in Coverage Data

IC 221316 under ICR 202509-0938-031 · OMB 0938-1310.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10572 Annual Submission of Transparency in Coverage Data	Form and Instruction
Form CMS-10572 QHP Issuer Data Collection - Appendix A2 Annual Submission of Transparency in Coverage Data	Form and Instruction
Form CMS-10572 Data Submission Template - Appendix C Annual Submission of Transparency in Coverage Data	Form and Instruction
Form CMS-10572 Data Elements - Appendix A1 Annual Submission of Transparency in Coverage Data	Form and Instruction
Form CMS-10572 Data Templates Appendix B Annual Submission of Transparency in Coverage Data	Form and Instruction
Form CMS-10572 Data Template Appendix B2 Annual Submission of Transparency in Coverage Data	Form and Instruction
Form CMS-10572 Data Template - Appendix D Annual Submission of Transparency in Coverage Data	Form and Instruction
CMS-10572 QHP Issuer Data Collection - Appendix A2 CMS-10572 - Appendix A2.docx	Form and Instruction
CMS-10572 QHP Issuer Data Collection - Appendix A2 CMS-10572 - Appendix A2.docx	Form and Instruction
CMS-10572 Data Submission Template - Appendix C CMS-10572 - Appendix C.docx	Form and Instruction
CMS-10572 Data Submission Template - Appendix C CMS-10572 - Appendix C.docx	Form and Instruction
CMS-10572 Data Elements - Appendix A1 CMS-10572 - Appendix A1.docx	Form and Instruction
CMS-10572 Data Elements - Appendix A1 CMS-10572 - Appendix A1.docx	Form and Instruction
CMS-10572 Data Templates Appendix B CMS-10572 - Appendix_B1_508.docx	Form and Instruction
CMS-10572 Data Templates Appendix B CMS-10572 - Appendix_B1_508.docx	Form and Instruction
CMS-10572 Data Template Appendix B2 CMS-10572 - Appendix B2.docx	Form and Instruction
CMS-10572 Data Template Appendix B2 CMS-10572 - Appendix B2.docx	Form and Instruction
CMS-10572 Data Template - Appendix D CMS-10572 - Appendix D.docx	Form and Instruction
CMS-10572 Data Template - Appendix D CMS-10572 - Appendix D.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Annual Submission of Transparency in Coverage Data

Agency IC Tracking Number:

10572

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 156.220 45 CFR 156.20

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10572	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10572	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10572	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10572	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10572	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10572	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	400	40	360
Annual IC Time Burden (Hours)	57,200	5,720	51,480
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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