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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
New
1240
186186
0
Form and Instruction
CMS-10433
Appendix A 1 Issuer data elements
Form and Instruction
CMS-10433
Appendix A 2 Program Attestations
Form and Instruction
CMS-10433
Appendix A 3 AdministrativeData Template
Form and Instruction
CMS-10433
Appendix A 4 EssentialCommunityProviders Template
Form and Instruction
CMS-10433
IssuerURAC
Form and Instruction
CMS-10433
IssuersNCQA
Form and Instruction
CMS-10433
Appendix A 6 Network Adequacy Template
Form and Instruction
CMS-10433
Appendix B 1 QHP Benefit Elements
Form and Instruction
CMS-10433
PlansBenefits
Form and Instruction
CMS-10433
PlansBenefitsAddIn
Form and Instruction
CMS-10433
Appendix B 3 PrescriptionDrug Template
Form and Instruction
CMS-10433
Appendix B 4 ServiceArea Template
Form and Instruction
CMS-10433
Appendix C 1 Rating Tables and Issuer Business Rules
Form and Instruction
CMS-10433
Appendix C 2 RateTables Template
Form and Instruction
CMS-10433
Appendix C 3 RatingBusinessRules Template
Reinsurance
New
1600
13333
0
Form and Instruction
CMS-10433
Appendix D 1 RI, RA, Banking, Edge Server Data Elements
Reinsurance and Risk Adjustment
New
600
3800
0
Form and Instruction
CMS-10433
Appendix D 1 RI, RA, Banking, Edge Server Data Elements
States
New
50
150
0
Total burden requested under this ICR:
3490
203469
0
To view an IC, click on IC Title