View Information Collection (IC)

View Information Collection (IC)

IC Title:	Notice of Rebate to Enrollees	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 158

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10418	MLR Notice 1 - Individual Market to Subscribers	MLR Notice 1 Individual Market - to Subscribers.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10418	MLR Notice 2 Group Markets - Rebate to Policyholder	MLR Notice 2 Group Markets - Rebate to Policyholder.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10418	MLR Notice 3 - Group Markets - Rebate to Subscribers	MLR Notice 3 Group Markets - Rebate to Subscribers.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10418	MLR Notice Instructions	MLR Notice Instructions.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 55	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	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	859,760	0	0	-4,849,285	0	5,709,045
Annual IC Time Burden (Hours)	21,494	0	0	-18,729	0	40,223
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.