Application

Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges

OMB: 0938-1119

IC ID: 195986

Information Collection (IC) Details

View Information Collection (IC)

Application
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction 0938-1119 - FOA - Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges.pdf Yes Yes Paper Only
Form and Instruction CMS-10371 FOA 0938-1119.Amended Exchange Establishment FOA.docx Yes No Fillable Fileable

Health Health Care Services

 

50 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 50 0 0 0 0 50
Annual IC Time Burden (Hours) 28,200 0 0 0 0 28,200
Annual IC Cost Burden (Dollars) 42,770 0 0 0 0 42,770

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