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Subpart H - Exchange Functions: Small Business Health Options Program
No Modified
Required to Obtain or Retain Benefits
45 CFR 155.716

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Data Elements CMS-10468 - Appendix A - Data Elements.pdf Yes Yes Printable Only

Health Health Care Services


10 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 40 0 0 -210 0 250
Annual IC Time Burden (Hours) 720 0 0 -1,280 0 2,000
Annual IC Cost Burden (Dollars) 71,240 0 0 -936,260 0 1,007,500

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