Information Collection

Data Elements for General Function of an Exchange

IC 223737 under ICR 201609-0938-029 · OMB 0938-1321.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10633 Data Elements for General Function of an Exchange	Form and Instruction
CMS-10633 Appendix A - Agents and Brokers Appendix A - Agents and Brokers 92916.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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-10633	Appendix A - Agents and Brokers	Appendix A - Agents and Brokers 92916.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 104,325

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	104,325	104,325
Annual IC Time Burden (Hours)	506,734	506,734
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.