Information Collection

State-based Marketplace Annual Reporting Tool (SMART)

IC 210245 under ICR 201402-0938-001 · OMB 0938-1244.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1244 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10507 State-based Marketplace Annual Reporting Tool (SMART) Form and Instruction
CMS-10507 STATE-BASED MARKETPLACE ANNUAL REPORTING TOOL (SMART) CMS-10507 - FINAL version_SMART_06-05-14CLEANjh.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State-based Marketplace Annual Reporting Tool (SMART)	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-10507	STATE-BASED MARKETPLACE ANNUAL REPORTING TOOL (SMART)	CMS-10507 - FINAL version_SMART_06-05-14CLEANjh.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 19	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	19	19
Annual IC Time Burden (Hours)	1,311	1,311
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.