Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
EHB Dental Plan Issuers Unchanged 20 10 0 Form and Instruction CMS-10448 Notice of Intent to Provide Dental Coverage in the Exchange
Essential Health Benefits Benchmark Plans and Accrediting Entities Data Collection Unchanged 158 632 0 Form and Instruction CMS-10448 EHB CMS State Benchmark
Form and Instruction CMS-10448 EHB Issuer Benchmark
Form and Instruction CMS-10448 State Mandate Template
Instruction
Form and Instruction CMS-10448 EHB Prescription Drug Template
Form and Instruction CMs-10448 Prescription Drug Formulary
Form and Instruction CMS-10448 EHB Benefits Template
Form and Instruction CMS-10448 EHB State Submission of State Mandates Template
Total burden requested under this ICR: 178 642 0  
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