View Information Collection (IC)

View Information Collection (IC)

Special Enrollment Periods 10468
No New
Required to Obtain or Retain Benefits
45 CFR 155.420

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10468 Appendix A - Enrollment Notices CMS-10468 - Appendix A - Enrollment Notices.pdf Yes No Fillable Fileable

Health Health Care Services


4,700 0
Private Sector Businesses or other for-profits
   0 %

  Requested 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 4,700 4,700 0 0 0 0
Annual IC Time Burden (Hours) 4,700 4,700 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.