OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Early Retiree Reinsurance Program

OMB 0938-1087 ยท HHS/CMS.

OMB 0938-1087

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-10321 (149.335) - Documentation of Actual Medical Claims InvolvedForm
0938-1087Revised_CrosswalkofChanges[1][1].doc Justification for No Material/Nonsubstantive Change
RevisionstoPRAPackage200938-1087Overview[1].docx Supplementary Document
0938-1087Revised_SummaryBurdenEstimates[1].docx Supplementary Document
0938-1087Revised_CrosswalkofChanges[1].doc Supplementary Document
0938-1087.Revised_Supporting_Statement.docSupporting Statement A
(149.700) - Reporting Change of Ownership Information collection
(149.610) - Requesting Reopenings Instruction
(149.600) - Reporting Previous Data Inaccuracies Instruction
(149.500 & 149.510) - Requesting Appeals Instruction
(149.350) Maintenance of Records Information collection
(149.335) - Documentation of Actual Medical Claims Involved Form
(149.40) - Updating Data in the Application Instruction
(149.35(b)(3)) - Procedures to Protect Against Fraud, etc. Information collection
(149.35(b)(2)) - Written Agreement with Issuer or Plan Information collection
Early Retiree Reinsurance Program Reopening Requests (Pub lic), for Program Years 2, 3, 4 Instruction
Early Retiree Reinsurance Program Appeals (Public), for Program Year 4 Instruction
Early Retiree Reinsurance Program Reopening Requests (Private), for Program Years 2, 3, 4 Instruction
Early Retiree Reinsurance Program Appeals (Public), for Program Years 2 and 3 Instruction
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Public) Program Year 4 Instruction
Early Retiree Reinsurance Program Appeals (Private), for Program Year 4 Instruction
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Public) Program Year 3 Instruction
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Public) Program Year 2 Instruction
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Private) Program Year 4 Instruction
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Private) Program Year 3 Instruction
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Private) Program Year 2 Instruction
Early Retiree Reinsurance Program Appeals (Private), for Program Years 2 and 3 Instruction
Private Application Update Year 2_3_4 Instruction
Public Application Update Year 2_3_4 Instruction
Private Data Inaccuracies Years 2_3_4 Instruction
Private CHOW Years 2_3_4 Instruction
Public CHOW Years 2_3_4 Instruction
Public Data Inaccuracies Years 2_3_4 Instruction
Private Maintenance of Records Year 2_3_4 Instruction
Public Maintenance of Records Year 2_3_4 Instruction
Public Fraud and Abuse Procedures Years 2_3_4 Instruction
Private Fraud and Abuse Procedures Years 2_3_4 Instruction
Private Written Agreement Year 2_3_4 Instruction
Public Written Agreement Year 2_3_4 Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
201202-0938-004 Revision of a currently approved collection 2012-02-14 Approved without change
201106-0938-023 Revision of a currently approved collection 2011-06-29 Approved with change
201012-0938-015 Revision of a currently approved collection 2010-12-21 Approved without change
201009-0938-016 Revision of a currently approved collection 2010-09-29 Approved without change
201005-0938-012 No material or nonsubstantive change to a currently approved collection 2010-05-26 Approved without change
201004-0938-012 New collection (Request for a new OMB Control Number) 2010-04-29 Approved with change