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Federal forms, ICRs, and supporting documents

Information Collection

Annual Submission of Transparency in Coverage Data

IC 221316 under ICR 202509-0938-031 · OMB 0938-1310.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Annual Submission of Transparency in Coverage Data 10572
 
No Modified
 
Mandatory
 
45 CFR 156.220 45 CFR 156.20

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10572 QHP Issuer Data Collection - Appendix A2 CMS-10572 - Appendix A2.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10572 Data Submission Template - Appendix C CMS-10572 - Appendix C.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10572 Data Elements - Appendix A1 CMS-10572 - Appendix A1.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10572 Data Templates Appendix B CMS-10572 - Appendix_B1_508.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10572 Data Template Appendix B2 CMS-10572 - Appendix B2.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10572 Data Template - Appendix D CMS-10572 - Appendix D.docx Yes Yes Fillable Fileable

Health Health Care Services

 

400 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 400 0 0 40 360 0
Annual IC Time Burden (Hours) 57,200 0 0 5,720 51,480 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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