Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Confirmations on the State EHB-benchmark Plan Modified 5 20 0 Form and Instruction CMS-10448
EHB Benchmark Plan Formulary Drug Modified 5 60 0 Form and Instruction CMS-10448
EHB Reporting - EHB Actuarial Certificate Template Modified 5 65 0 Form and Instruction CMS-10488
Form and Instruction CMS-10448
Form and Instruction CMS-10448
Form and Instruction CMS-10448
Form and Instruction CMS-10448
State's EHB-benchmark Plan's Benefits and Limits Modified 5 60 0 Form and Instruction CMS-10448
Total burden requested under this ICR: 20 205 0  
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