Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Employers - Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment Unchanged 13200 960 53196000 Other-Data Elements
Exchanges - Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment Unchanged 18 137819 576436 Other-Data elements
Individual - Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing andAppeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment Unchanged 18 120 1134 Other-Data Elements
Special Enrollment Periods New 4700 4700 0 Form CMS-10468 Appendix A - Enrollment Notices
Total burden requested under this ICR: 17936 143599 53773570  
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