Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Collection of User Fee Adjustment Information from FFE (or SBE-FP) Participating Issuers New 40 200 0 Instruction
Data Submission and Maintenance of Records for Individual Contraceptive Arrangement New 252800 379200 0
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
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
Form and Instruction CMS-10492
Total burden requested under this ICR: 253165 380850 0  
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