Special Enrollment Periods

Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment (CMS-10468)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1207 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10468 Special Enrollment Periods Form
CMS-10468 Appendix A - Enrollment Notices CMS-10468 - Appendix A - Enrollment Notices.pdf Form

Information Collection (IC) Details

IC Title:	Special Enrollment Periods	Agency IC Tracking Number:	10468

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.420

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10468	Appendix A - Enrollment Notices	CMS-10468 - Appendix A - Enrollment Notices.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,700	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	4,700	4,700
Annual IC Time Burden (Hours)	4,700	4,700
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.