Information Collection

Operational Metrics - Monthly Reports

IC 208345 under ICR 201411-0938-005 · OMB 0938-1119.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Operational Metrics - Monthly Reports

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
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
Form and Instruction	CMS-10371	Operational Metric â 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

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 %

table that charts list of burden
	Approved	Previously Approved
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

table that charts IC Documents
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.