Exchanges

Establishment of Qualified Health Plans and American Health Benefit Exchanges (CMS-10400)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1156 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	Exchanges	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.410, 430, 705, 715, 720 45 CFR 155.1055, 1065, 1075, 1080 45 CFR 155.105, 106, 110, 150, 160 45 CFR 155.200, 205, 210, 220, 260 45 CFR 155.725, 730, 1020, 1040 45 CFR 155.335, 340, 345, 400, 405 45 CFR 155.302, 310, 315, 320, 330

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-1,479	1,479
Annual IC Time Burden (Hours)	-243,984	243,984
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.