Information Collection

GenIC #16 (Extension w/o change): Federally-Facilitated Marketplace (FFM) Integration Data Collection Tool

IC 229613 under ICR 201712-0938-019 · OMB 0938-1148.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1148 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10398 #16 GenIC #16 (Extension w/o change): Federally-Facilitated Marketplace (FFM) Integration Data Collection Tool Form
CMS-10398 #16 Federally Facilitated Marketplace and State Based Rules 16 - FFM and State Based Rules Integration Charts.xlsx Form
CMS-10398 #16 Federally Facilitated Marketplace and State Based Rules 16 - FFM and State Based Rules Integration Charts.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	GenIC #16 (Extension w/o change): Federally-Facilitated Marketplace (FFM) Integration Data Collection Tool	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10398 #16	Federally Facilitated Marketplace and State Based Rules Integration Charts	16 - FFM and State Based Rules Integration Charts.xlsx		Yes	Yes	Fillable Fileable
Form	CMS-10398 #16	Federally Facilitated Marketplace and State Based Rules Integration Charts	16 - FFM and State Based Rules Integration Charts.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	1,120	1,120
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.