Information Collection

Weekly Reporting

IC 212550 under ICR 202003-0938-004 · OMB 0938-1215.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1215 can be found here:

Documents and Forms

Document Name Document Type
CMS-10463 - Navigator Reporting Requirements.pdf Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Weekly Reporting	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.210

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-10463 - Navigator Reporting Requirements.pdf		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	2,600	-2,704	5,304
Annual IC Time Burden (Hours)	21,850	4,612	17,238
Annual IC Cost Burden (Dollars)	891,800	-110,656	1,002,456

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.