Issuer - Data Entry (Individual)

Health Care Reform Insurance Web Portal Requirements 45 CFR part 159 (CMS-10320)

Documents and Forms

Document Name Document Type
Form CMS-10320 Issuer - Data Entry (Individual) Form and Instruction
CMS-10320 - Appendix C Insurance Issuer and Product Level Data.pdf Instruction
CMS-10320 - Appendix C Insurance Issuer and Product Level Data.pdf Instruction
CMS 10320 Appendix D_Data Collection_PRA2020.pdf Instruction
CMS 10320 Appendix D_Data Collection_PRA2020.pdf Instruction
CMS-10320 Issuer Instructions and Instruments CMS-10320.Issuer - FINAL Instructions and Instruments (5-12-10).pdf Form and Instruction
CMS-10320 Issuer Instructions and Instruments CMS-10320.Issuer - FINAL Instructions and Instruments (5-12-10).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Issuer - Data Entry (Individual)	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10320	Issuer Instructions and Instruments	CMS-10320.Issuer - FINAL Instructions and Instruments (5-12-10).pdf	Yes	Yes	Fillable Fileable
Instruction			CMS-10320 - Appendix C Insurance Issuer and Product Level Data.pdf	Yes	Yes	Paper Only
Instruction			CMS 10320 Appendix D_Data Collection_PRA2020.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	500	50	450
Annual IC Time Burden (Hours)	2,000	200	1,800
Annual IC Cost Burden (Dollars)	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.