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Verification of New and Changed Applications
Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions
OMB: 0938-1190
IC ID: 205756
OMB.report
HHS/CMS
OMB 0938-1190
ICR 201311-0938-010
IC 205756
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1190 can be found here:
2024-03-14 - Revision of a currently approved collection
2020-03-25 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Verification of New and Changed Applications
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 155.615
45 CFR 155.620
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
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:
18
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
0 %
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
18
0
0
0
0
18
Annual IC Time Burden (Hours)
22
0
0
0
0
22
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.