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View Information Collection (IC)

View Information Collection (IC)

Health Insurance Benefit Agreement and Supporting Regulations at 42 CFR Part 489 and 491
 
No Modified
 
Mandatory
 
42 CFR 489 42 CFR 491

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-1561 Yes Yes Fillable Fileable
Form and Instruction CMS-1561A Yes Yes Fillable Fileable

Health Health Care Services

 

2,050 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,050 0 0 0 0 2,050
Annual IC Time Burden (Hours) 2,050 0 0 0 0 2,050
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-1561 (tracked version) 11/25/2025
CMS-1561A (Tracked version) 11/25/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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