Information Collection

Good Cause Processes (Sec. 417.460, 422.74, and 423.44)

IC 215417 under ICR 202607-0938-004 · OMB 0938-1271.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Good_Cause_Section_60.3.4.1_Chapter 2_MMCM _incl_Exhibits.pdf 60.3.4.1- Process for Good Cause Determinations for Nonpayment of Plan Premiums	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 422.74 42 CFR 417.460 42 CFR 423.44

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54,789

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	54,789	13,500	41,289
Annual IC Time Burden (Hours)	36,490	8,991	27,499
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
60.3.4.1- Process for Good Cause Determinations for Nonpayment of Plan Premiums		11/02/2022

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

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