Operational Metrics - Monthly Reports

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1119 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10371 Operational Metrics - Monthly Reports Form and Instruction
CMS-10371 Exchange Establishment Grants FOA 2012 Exchange Establishment FOA 02_21_12 clean for PRA posting DRAFT.docx Form and Instruction
CMS-10371 Operational Metric – SBM Open Enrollment Weekly Indicato 0938-1119 (Operational Metric) SBM Open Enrollment Weekly Indicators Rev 9_5_2013 Word-508.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Operational Metrics - Monthly Reports	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	Operational Metric – SBM Open Enrollment Weekly Indicators	0938-1119 (Operational Metric) SBM Open Enrollment Weekly Indicators Rev 9_5_2013 Word-508.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10371	Exchange Establishment Grants FOA	2012 Exchange Establishment FOA 02_21_12 clean for PRA posting DRAFT.docx		No	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	2,304	2,304
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.