View Information Collection (IC)

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Bundle: #7 (CHIPRA Cycle III and IV) and #41 (1095 B Reporting)
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10398 (#7) Cycle III Semi-Annual Report Template 7 CHIPRA Cycle III reporting template Final [rev 04-15-2015 by OSORA PRA].doc Yes Yes Fillable Printable
Form and Instruction CMS-10398 (#7) Cycle IV Semi-Annual Report Template 7 CHIPRA Cycle IV Template.docx Yes Yes Fillable Printable
Form and Instruction CMS-10398 (#7) Cycle III Final Report Addendum Cycle III Final Report Template due 10 13 15 kf+mr (7).doc Yes Yes Fillable Printable
Form CMS-10398 (#41) 1095 B Reporting (Conf Call Questions) 1095 B Reporting [rev 07-09-2015 by OSORA PRA].docx No   Paper Only

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   50 %

  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 97 0 97 0 0 0
Annual IC Time Burden (Hours) 138 0 138 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
41 - Supporting Statement 41 - Supporting Statement [rev 07-09-2015 by OSORA PRA].docx 07/09/2015
Bundled Burden Summary Table Bundled Burden Table (07-09-2015 submission).xlsx 07/09/2015
7 - Supporting Statement 7 - Supporting Statement [rev 07-09-2015 by OSORA PRA].doc 07/09/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.