Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
EHB Dental Plan Issuers Unchanged 175 88 0
EHB Reporting Modified 400 470 0 Form and Instruction CMS-10488 EHB Confirmation Template
Form and Instruction CMS-10448 EHB Benchmark Plan Certification
Form and Instruction CMS-10448 Benchmark Plans Prescription Template
Form and Instruction CMS-10448 Summary of Benefits Template
EHB Substitution Modified 5 3 0 Form and Instruction CMS-10488 Substitution Notification
Reporting - State Mandates New 41 1763 0 Form and Instruction CMS-10448 State Annual Report
Form and Instruction CMS-10448 State Certification Annual Report (SBRs)
Total burden requested under this ICR: 621 2324 0  
To view an IC, click on IC Title