Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.
Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)	Modified	205	120	0	Form and Instruction	CMS-10492
Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer)	Modified	40	443	0	Form and Instruction	CMS-10492
	Modified	40	443	0	Form and Instruction	CMS-10492
Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs)	Modified	80	887	0	Form and Instruction	CMS-10492
	Modified	80	887	0	Form and Instruction	CMS-10492
Total burden requested under this ICR:		325	1450	0
To view an IC, click on IC Title