Form CMS-10464 Agent/Broker Registration Collection Tool

OMB control number: 0938-1204
Expiration Date: XX/XX/2022
AB PRA Screenshots
Image 1
CMS Enterprise Portal Login Page

Image 2
Portal new user account information page example

PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1204, expiration
date is XX/XX/2022. The time required to complete this information collection is estimated to take 36 minutes (24 minutes for
new agent/brokers issuers per response) and 12 minutes (for returning agent/brokers per response) which includes the time
to complete the Federally-facilitated Exchange (FFE) registration and training. If you have comments concerning the accuracy
of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA
Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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Identity Proofing Page Example. Agent Broker completes remote identity proofing within enterprise
Portal.

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Image 4
Out-of-Wallet Questions Page Example. Agent Broker is asked questions to verify their identity based on
information provided on Identity Proofing page example (see: Image 3).

Image 5
Both an Individual and SHOP Maketplace Agent Broker Page Example

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