View Information Collection (IC)

View Information Collection (IC)

IC Title:	Issuer - Attest (Small Group)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10320	CMS-10320.Issuer - FINAL Instructions and Instruments	CMS-10320.Issuer - FINAL Instructions and Instruments (5-12-10).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10320	Appendix C - Insurance Issuer and Product Level Data	CMS-10320 - Appendix C Insurance Issuer and Product Level Data.pdf		Yes	No	Fillable Fileable
Form and Instruction	CMS-10320	Appendix D - Data Collection 2014	CMS-10320 - Appendix D_Data Collection2014.pdf		Yes	No	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 700	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	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	700	0	0	0	0	700
Annual IC Time Burden (Hours)	1,400	0	0	0	0	1,400
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.