OMB control number
Pre-Existing Condition Insurance Plan and Supporting Regulations
OMB 0938-1100 · HHS/CMS.
OMB 0938-1100
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10339 Proposal Modification | Form and Instruction |
 Form CMS-10339 Record Retention | Form and Instruction |
| Form CMS-10339 Audit | Form and Instruction |
| Form CMS-10339 Audited Financial Report | Form and Instruction |
| Form CMS-10339 Quarterly and Monthly Reporting | Form and Instruction |
| state_solicitation.pdf | Supplementary Document |
| PCIP Model Contract.pdf | Supplementary Document |
| CMS-10339 Supporting_Statement_Part_A.pdf | Supporting Statement A |
 Proposal Modification |
Form and Instruction |
| Record Retention |
Form and Instruction |
| Audit |
Form and Instruction |
| Reports of Insurer Dumping (42 CFR 152.28) |
Information collection |
| Audited Financial Report |
Form and Instruction |
| Quarterly and Monthly Reporting |
Form and Instruction |
| Fraud, Waste, and Abuse (42 CFR 152.27) |
Information collection |
| Payment Invoices (42 CFR 152.32) |
Information collection |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201308-0938-003 | Extension without change of a currently approved collection | 2013-08-06 | Approved without change | |
| 201102-0938-007 | Revision of a currently approved collection | 2011-02-10 | Withdrawn and continue | |
| 201012-0938-022 | Extension without change of a currently approved collection | 2010-12-30 | Approved without change | |
| 201012-0938-019 | Revision of a currently approved collection | 2010-12-30 | Approved without change | |
| 201007-0938-013 | New collection (Request for a new OMB Control Number) | 2010-07-26 | Preapproved |