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Federal forms, ICRs, and supporting documents

Information Collection

Notice of Rebate to Enrollees

IC 201983 under ICR 201304-0938-002 · OMB 0938-1164.

Documents and Forms
Document Name
Document Type
Form
Instruction
Instruction
Instruction
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Notice of Rebate to Enrollees
 
No Modified
 
Mandatory
 
45 CFR 158

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10418 Notice_#1_to_Subscribers_in_Individual_Market 508CMS-10418_Notice_#1_to_Subscribers_in_Individual_Market.pdf Yes Yes Fillable Fileable
Form CMS-10418 Notice_#2_Group_Markets_Rebate_to_Policyholder 508CMS-10418_Notice_#2_Group_Markets_Rebate_to_Policyholder.pdf Yes No Fillable Fileable
Form CMS-10418 Notice_#3_Group_Markets_Rebate_to_Subscribers 508CMS-10418_Notice_#3_Group_Markets_Rebate_to_Subscribers.pdf Yes No Fillable Fileable
Instruction 508CMS-10418_MLR_Rebate_Notice_Instructions.pdf Yes No Fillable Fileable
Instruction 2012 0510 MLR Rebate Notice Instructions FINAL.docx Yes No Fillable Fileable
Instruction 2012 0510 Guidance re Rebate Notices FINAL.docx Yes No Fillable Fileable

Health Health Care Services

 

120 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 8,324,640 0 0 1,119,501 0 7,205,139
Annual IC Time Burden (Hours) 68,048 0 0 9,151 0 58,897
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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