View Information Collection (IC)

View Information Collection (IC)

Essential Health Benefits Benchmark Plans and Accrediting Entities Data Collection
 
No New
 
Voluntary
 
45 CFR 156.120

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10448 EHB Issuer Benchmark EHBIssuerBenchmark.xls Yes Yes Fillable Fileable
Form and Instruction CMS-10448 EHB CMS State Benchmark EHBCmsStateBenchmark.xls Yes Yes Fillable Fileable
Form and Instruction CMS-10448 State Mandate Template StateMandateTemplate.xls Yes Yes Fillable Fileable
Instruction Appendix_C-1_EHB Benchmark Submission Instructions 08-14-2012.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10448 EHB Prescription Drug Template Appendix_C-3_EHB Prescription Drugs Template 07-18-2012.pdf Yes Yes Fillable Fileable
Form and Instruction CMs-10448 Prescription Drug Formulary PrescriptionDrugFormulary.xls Yes Yes Fillable Fileable
Form and Instruction CMS-10448 EHB Benefits Template Appendix_C-2_EHB Benefits Template 07-18-2012.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10448 EHB State Submission of State Mandates Template 508Appendix_C-5_EHB State Submission of State Mandates 05-24-2012.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

153 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  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 153 0 153 0 0 0
Annual IC Time Burden (Hours) 612 0 612 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Appendix B - Benchmark Plan Data Requirements Appendix_B_EHB_Elements 08-14-2012.docx 08/15/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.