Information Collection

Subpart H - Exchange Functions: Small Business Health Options Program

IC 207760 under ICR 202604-0938-004 · OMB 0938-1207.

Documents and Forms

Document Name Document Type
CMS-10468 - Appendix A - Data Elements.pdf Other-Data Elements

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Subpart H - Exchange Functions: Small Business Health Options Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.716

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Elements			CMS-10468 - Appendix A - Data Elements.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	720	720
Annual IC Cost Burden (Dollars)	71,240	71,240

Documents for IC

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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