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

ICR 201111-0938-011

OMB: 0938-1119

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2011-11-22
Supporting Statement A
2011-11-22
IC Document Collections
ICR Details
0938-1119 201111-0938-011
Historical Active 201107-0938-018
HHS/CMS
Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 11/28/2011
Retrieve Notice of Action (NOA) 11/22/2011
  Inventory as of this Action Requested Previously Approved
09/30/2014 09/30/2014 09/30/2014
700 0 700
69,650 0 69,650
42,770 0 42,770

Information collected as a part of the application for this grant will be used to evaluate the applications and determine awardees. Information collected pursuant to the reporting requirements for awardees will be used to evaluate the progress of States in planning for and implementing Exchanges, and determine how the Secretary can provide assistance to achieve the goals of the grant program and the Affordable Care Act.

PL: Pub.L. 111 - 148 1311 Name of Law: Affordable choices of health benefit plans
  
None

Not associated with rulemaking

No

6
IC Title Form No. Form Name
Application CMS-10371 FOA
Performance Reviews CMS-10371 FOA
Periodic Reporting CMS-10371 FOA
Public CMS-10371 FOA
Quarterly CMS-10371, CMS-10371, CMS-10371, CMS-10371 Quarterly Instrument ,   Quarterly Data Elements ,   Quarterly Instrument Revised ,   Quarterly Data Elements Revised
Work Plan Update CMS-10371 FOA

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 700 700 0 0 0 0
Annual Time Burden (Hours) 69,650 69,650 0 0 0 0
Annual Cost Burden (Dollars) 42,770 42,770 0 0 0 0
No
No

$3,760
No
No
Yes
No
No
Uncollected
William Parham 4107864669

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/22/2011


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