View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Basic Health Plan State Report for Health Insurance Exchange Premiums
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-PRA Disclosure Statement BHP Disclosure Statement 11182013.doc Yes No Printable Only
Form and Instruction CMS-10510 BHP State Report for Exchnage Premiums Copy of BHP State Report for Exchange Premiums 4-7-2014.pdf Yes Yes Fillable Printable

Health Health Care Services

 

17 0
   
State, Local, and Tribal Governments
 
   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 17 0 0 0 0 17
Annual IC Time Burden (Hours) 68 0 0 0 0 68
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk Crosswalk 4 7 2014 (rev 6-27-2014 by OSORA PRA).xlsx 06/27/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.