Disclosure of State Rating Requirements and Individual Market Special Enrollment Notice (CMS-10454)

ICR 202108-0938-006

OMB: 0938-1258

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1258 can be found here:

2022-12-06 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Document Name	Status
Form CMS-10454 Disclosure of State Rating Requirements Form and Instruction	Unchanged
Form CMS-10454 Disclosure of State Rating Requirements Form and Instruction	Unchanged
CMS-10454 - Non-Sub Change Request.docx Justification for No Material/Nonsubstantive Change	2021-08-12
CMS-10454 - Non-Sub Change Request.docx Justification for No Material/Nonsubstantive Change	2021-08-12
CMS-10454 Supporting Statementf - Part A -.docx Supporting Statement A	2021-03-18
CMS-10454 Supporting Statementf - Part A -.docx Supporting Statement A	2021-03-18

IC Document Collections

IC ID	Document Title	Status
208568	Disclosure of State Rating Requirements Form and Instruction	Unchanged
208568	Disclosure of State Rating Requirements Form and Instruction	Unchanged

ICR Details

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