Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
QHP Certification Modified 975 182325 0 Form CMS-10433 Data Template Administrative
Form CMS-10433 Medical Essential Community Providers
Form CMS-10433 Dental Essential Community Provider
Form CMS-10433 URAC Application
Form CMS-10433 NCQA Template
Form CMS-10433 AAAHC
Form CMS-10433 Network Adequacy
Form CMS-10433 Program Attestations
Form CMS-10433 Accreditation Attestations
Form CMS-10433 Plan and Benefit
Form CMS-10433 Prescription Drugs Template
Form CMS-10433 Service Area
Form CMS-10433 Network ID
Form CMS-10433 Rates Table
Form CMS-10433 Business Rules
Instruction
Reinsurance Modified 23800 119000 0 Instruction
Reinsurance and Risk Adjustment Modified 2400 15800 0 Instruction
States Unchanged 50 150 0
Total burden requested under this ICR: 27225 317275 0  
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