OMB
.report
Search
Performance Reviews
Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges
OMB: 0938-1119
IC ID: 198687
OMB.report
HHS/CMS
OMB 0938-1119
ICR 201107-0938-018
IC 198687
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1119 can be found here:
2024-04-11 - No material or nonsubstantive change to a currently approved collection
2023-03-10 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form CMS-10371
Performance Reviews
Form and Instruction
0938-1119 - FOA - Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges.pdf
Instruction
CMS-10371 FOA
CMS-10371.FOA document.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Performance Reviews
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CMS-10371
FOA
CMS-10371.FOA document.docx
Yes
Yes
Fillable Fileable
Instruction
0938-1119 - FOA - Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges.pdf
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
50
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
50
0
0
0
Annual IC Time Burden (Hours)
5,750
0
5,750
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.