Training Registration

Patient Protection and Affordable Care Act; Consumer Assistance Tools and Programs of an Exchange and Certified Application Counselors; Exchange and Insurance Market Standards for 2015

Documents and Forms

Document Name Document Type
Form CMS-10472 Training Registration Form and Instruction
CMS-10472 Training Quality Questionnaire Appendix F_Training Quality Questionnaire.pdf Form and Instruction
CMS-10472 Sample Training Completion Certificate Appendix B_ SampleTraining Completion Certificate.pdf Form and Instruction
CMS-10472 Registration Portal Appendix A_Registration Portal.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Training Registration	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.215

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10472	Training Quality Questionnaire	Appendix F_Training Quality Questionnaire.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10472	Sample Training Completion Certificate	Appendix B_ SampleTraining Completion Certificate.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10472	Registration Portal	Appendix A_Registration Portal.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,510	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	3,510	3,510
Annual IC Time Burden (Hours)	1,327	1,327
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.