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Federal forms, ICRs, and supporting documents

Information Collection

Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)

IC 217425 under ICR 202208-0938-009 · OMB 0938-1285.

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

View Information Collection (IC)

Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 156.50(d)(2)(i)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10492 Notice of Availability of Separate Contraception Payments from Fully Insured Issuers CMS-10492 - Issuer and TPA data elements for FFE adjustment.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

205 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 205 0 0 -120 325 0
Annual IC Time Burden (Hours) 120 0 0 -286 406 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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