Appendix B - Registration Data Elements

CMS-10494 - APPENDIX B CMS-2334-F2.PDF

Standards for Navigators and Non-Navigator Assistance Personnel; Consumer Assistance Tools and Programs of an Exchange and Certified Application Counselors

Appendix B - Registration Data Elements

OMB: 0938-1205

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1205 can be found here:

2022-10-25 - No material or nonsubstantive change to a currently approved collection
2021-11-03 - Revision of a currently approved collection

Document [pdf]

Download: pdf | pdf

APPENDIX B
Registration Data Elements
User ID (Self assigned during the CMS Enterprise Portal registration)
First Name
Last Name
E-mail Address
Phone Number
State
Zip Code
User Type – Agent/Broker (role and NPN), Navigators (employer or
grantee organization), Certified application counselor (organization)

File Type	application/pdf
Author	Tricia Beckmann
File Modified	2013-07-10
File Created	2013-07-10