Information Collection

Product Discontinuance Notice for Issuers Outside the Marketplace (Non-QHP)

IC 212940 under ICR 202611-0938-016 · OMB 0938-1254.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10527 Discontinuation Notices Product Discontinuance Notice for Issuers Outside the Marketplace (Non-QHP)	Form and Instruction
Form CMS-10527 Federal Standard Notices Product Discontinuance Notice for Issuers Outside the Marketplace (Non-QHP)	Form and Instruction
CMS-10527 Discontinuation Notices CMS-10527 Attachment 3 - Discontinuation Notice with Auto Enrollment Off Exchangef.docx	Form and Instruction
CMS-10527 Federal Standard Notices CMS-10527 Attachment 5 - Discontinuation Notice without Auto Enrollment Off Exchangef.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 146.152 45 CFR 148.122 45 CFR 147.106

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
Form and Instruction	CMS-10527				Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10527				Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,206

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: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	2,726	2,726
Annual IC Time Burden (Hours)	20,207	20,207
Annual IC Cost Burden (Dollars)	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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