Exemption Applications - Eligibility for Exemptions

Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1190 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	Exemption Applications - Eligibility for Exemptions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.610 45 CFR 155.615 45 CFR 155.620 45 CFR 155.625

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,000,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	12,000,000	12,000,000
Annual IC Time Burden (Hours)	3,240,000	3,240,000
Annual IC Cost Burden (Dollars)	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.