CMS-10433 Service Area Template

Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations (CMS-10433)

AppI_NONFUNCTIONAL_ServiceArea.xls

QHP Certification

OMB: 0938-1187

Document [xlsx]
Download: xlsx | pdf

All fields with an asterisk (*) are required


If macros are disabled, press and hold the ALT key and press the F, then I, and then N key. After that, select the Enable All Content option by pressing enter. (note that you can also press the C key to select "Enable All Content") Instructions can be found in cells B1 through B5. To validate, press the Validate button or Ctrl + Shift + I. To finalize, press the Finalize button or Ctrl + Shift + F



Click Create Service Area IDs button (or Ctrl + Shift + R) to Create Service Area IDs based on your state



Service Area IDs will populate in the drop-down box in Service Area ID column


For each row, enter one County for that Service Area ID (unless the Service Area covers entire state)


HIOS Issuer ID:*



Issuer State:*
















Service Area ID* Service Area Name* State* County Name Partial County
Required:
Enter the Service Area ID
Required:
Enter the Service Area Name
Required:
Does this Service Area cover the entire state?
Required if State is "No":
Select the County - FIPS this Service Area covers
Required if State is "No":
Does this Service Area include a partial county?

File Typeapplication/vnd.ms-excel
File TitleService Area Template
SubjectService Areas
AuthorCGI Federal
Last Modified ByO'Brien, Tayseer
File Modified2019-01-28
File Created2012-03-17

© 2024 OMB.report | Privacy Policy