Essential Health Benefits Benchmark Plans (CMS-10448)

ICR 202311-0938-014

OMB: 0938-1174

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1174 can be found here:

2024-08-09 - Reinstatement with change of a previously approved collection

Forms and Documents

Document Name	Status
Form CMS-10448 EHB Benchmark Plan Formulary Drug Form and Instruction	Modified
Form CMS-10448 State's EHB-benchmark Plan's Benefits and Limits Form and Instruction	Modified
Form CMS-10488 EHB Reporting - EHB Actuarial Certificate Template Form and Instruction	Modified
Form CMS-10448 Confirmations on the State EHB-benchmark Plan Form and Instruction	Modified
CMS-10448_EHB_Substantive_Supporting_Statement_508.docx Supporting Statement A	2024-02-12

IC Document Collections

IC ID	Document Title	Status
241291	EHB Benchmark Plan Formulary Drug Form and Instruction	Modified
231104	State's EHB-benchmark Plan's Benefits and Limits Form and Instruction	Modified
229047	EHB Reporting - EHB Actuarial Certificate Template Form and Instruction	Modified
203740	Confirmations on the State EHB-benchmark Plan Form and Instruction	Modified

ICR Details

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