№ files_lp_4_process_1_36683
Government administrative application form issued by the U.S. Department of Health and Human Services requesting organizational, plan, and financial information from employment-based health plan sponsors seeking participation in the Early Retiree Reinsurance Program.
Year: Not specified
Country: United States
Issuing authority: U.S. Department of Health and Human Services
Administering agency: Centers for Medicare & Medicaid Services
Form number: CMS-10321
OMB control number: 0938-1087
Program: Early Retiree Reinsurance Program
Document type: Government application form
Subject: Employer-based health plan reimbursement for early retiree medical costs
Applicants: Plan sponsors including government, union, religious, commercial, or non-profit organizations
Required information: Plan sponsor data, authorized representative details, account manager details, plan information, benefit options, chronic and high-cost condition programs, reimbursement estimates, intended use of reimbursements
Estimated completion time: 35 hours
Legal reference: Paperwork Reduction Act of 1995
Associated institution address: CMS, 7500 Security Boulevard, Baltimore, Maryland 21244-1850
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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