Recertification request by organization

Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel (CAC)

OMB: 0938-1205

IC ID: 216274

Information Collection (IC) Details

View Information Collection (IC)

Recertification request by organization
 
No New
 
Required to Obtain or Retain Benefits
 
45 CFR 155.225

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10494 Recertification Request Form CMS-10494 - Appendix L_Model Recertification Request Form.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

5,000 0
   
Private Sector Not-for-profit institutions
 
   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 5,000 0 0 5,000 0 0
Annual IC Time Burden (Hours) 12,020 0 0 12,020 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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