Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Mandatory Insurer Reporting (GHP-Private) Modified 3515000 292905 0 Instruction
Mandatory Insurer Reporting (GHP-State, Local, Tribal Gov't) Modified 185000 15417 0 Instruction
Mandatory Insurer Reporting (Non-GHP, Federal) Modified 41122 3427 0 Form and Instruction CMS-10265 Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, Federal, System Set-up and Administrative) Modified 1077 12305 0 Form and Instruction CMS-10265 Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, Private - System Set-up and Administration) Modified 19920 312246 0 Form and Instruction CMS-10265 Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, Private) Modified 2883280 240264 0 Form and Instruction CMS-10265 Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt.) Modified 1400 117 0 Form and Instruction CMS-10265 Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt., System Set-up and Administration) Modified 100 743 0 Form and Instruction CMS-10265 Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Private, Administrative) Modified 1550 3100 0 Instruction
Mandatory Insurer Reporting (Private, System Set-up) Modified 1550 47508 0 Instruction
Mandatory Insurer Reporting (State, Local, Tribal Govt, System Set-up) Modified 100 3065 0 Instruction
Mandatory Insurer Reporting (State, Local, Tribal Govt., Administrative) Modified 100 200 0 Instruction
Total burden requested under this ICR: 6650199 931297 0  
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