Information Collection

Agents/Broker Data Collection in Federally Facilitated Health Insurance Exchanges

IC 207074 under ICR 201507-0938-007 · OMB 0938-1204.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1204 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10464 Agents/Broker Data Collection in Federally Facilitated Health Insurance Exchanges	Form and Instruction
CMS-10464 Agent/Broker Registration Collection Tool CMS-10464 - Agent Broker Registration Collection Tool.pdf	Form and Instruction
CMS-10464-30 day Appendix B data elements.pdf Appendix B - Training Registration Data Elements	IC Document

IC Title:

Agents/Broker Data Collection in Federally Facilitated Health Insurance Exchanges

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.220

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-10464	Agent/Broker Registration Collection Tool	CMS-10464 - Agent Broker Registration Collection Tool.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 172,525

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	172,525	-177,475	350,000
Annual IC Time Burden (Hours)	72,461	-102,539	175,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix B - Training Registration Data Elements	CMS-10464-30 day Appendix B data elements.pdf	05/23/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.