View Information Collection (IC)

View Information Collection (IC)

IC Title:	Notice of rebates to Subscribers and Policyholders	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
Other-Template			MLR Notice 1 Individual Market- Rebate to Subsribers.pdf		Yes	No	Paper Only
Other-Template			MLR Notice 2 Group Markets - Rebate to Policyholder.pdf		Yes	No	Printable Only
Other-Template			MLR Notice 3 Group Markets - Rebate to Subscribers.pdf		Yes	No	Printable Only

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: 114	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 %

	Requested	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	4,200,368	0	0	-3,050,444	0	7,250,812
Annual IC Time Burden (Hours)	38,824	0	0	-26,281	0	65,105
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.