OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

States - Data submission

IC 192725 under ICR 202510-0938-001 · OMB 0938-1086.

Documents and Forms
Document Name
Document Type
Form and Instruction
Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

States - Data submission
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10320 Health Care Reform Insurance Web Portal Requirements - State Instructions and Instrument CMS-10320.FINAL State Instructions and Instrument.pdf Yes No Fillable Fileable Signable
Instruction CMS-10320 Appendix_E_StateRequirements.pdf Yes No Paper Only

Health Health Care Services

 

50 0
   
State, Local, and Tribal Governments
 
   100 %

  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 0 0 0 -50 50 0
Annual IC Time Burden (Hours) 0 0 0 -25 25 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Data Collection Template CMS 10320 Appendix G_2020 .xlsm 01/28/2022
State Risk Pool CMS-10320 Appendix_F_PoolRequirements.2017_v2.pdf 01/28/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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