Annual Report

Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges (CMS-10371)

OMB: 0938-1119

IC ID: 208344

Information Collection (IC) Details

View Information Collection (IC)

Annual Report
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10371 Annual Report Template CMS-10371 - Progress_Report_Instrument.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10371 Annual Reporting Data Elements CMS-10371 - Progress_Report-Data_Elements.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

18 0
   
State, Local, and Tribal Governments
 
   100 %

  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 2 0 16
Annual IC Time Burden (Hours) 540 0 0 -100 0 640
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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