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Agenda
Reg Review
ICR
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