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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
QHP Certification
Modified
215
42140
0
Form and Instruction
CMS-10433
Administrative Data Template
Form and Instruction
CMS-10433
Plan Benefits Template
Form and Instruction
CMS-10433
Network ID Template
Form and Instruction
CMS-10433
Plans and Benefits Template
Form and Instruction
CMS-10433
Prescriptions Drug Formulary Template
Form and Instruction
CMS-10433
Rate Table Template
Form and Instruction
CMS-10433
Service Area Template
Form and Instruction
CMs-10433
Business Rules Template
Form and Instruction
CMS-10433
QHP Certification Instrument Screenshots
Form and Instruction
CMS-10433
Reinsurance Program and Risk Adjustment Program
Risk Adjustment
Modified
2400
7800
0
Form and Instruction
CMS-10433
Reinsurance and Risk Adjustment Bank Server
Stand-Alone Dental Issuers: QHP Certification
Modified
270
21600
0
States: SBE's, Federal Platform and Partnership States
Modified
40
120
0
Total burden requested under this ICR:
2925
71660
0
To view an IC, click on IC Title