155.225(b)(1)(i) (certificate issuance)

Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel -CAC (CMS-10494)

OMB: 0938-1205

IC ID: 207938

Information Collection (IC) Details

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155.225(b)(1)(i) (certificate issuance)
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 155.225(b)(1)(i)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10494 Training Certificate CMS-10494 - Appendix E_ SampleTraining Completion Certificate.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10494 Training Certificate (English) CMS-10494 - Appendix H_Sample Certification Certificate English.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10494 Sample Certification Certificate (Spanish) CMS-10494 - Appendix I_Sample Certification Certificate Spanish.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

5,000 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   80 %

  Requested 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 30,000 0 0 0 0 30,000
Annual IC Time Burden (Hours) 480 0 0 0 0 480
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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