States - Data Collection

Health Care Reform Insurance Web Portal Requirements 45 CFR part 159 (CMS-10320)

Documents and Forms

Document Name Document Type
Form CMS-10320 States - Data Collection Form and Instruction
CMS-10320 Appendix_E_State Requirements.pdf Instruction
CMS-10320 Appendix_E_State Requirements.pdf Instruction
CMS-10320 State instructions and instruments CMS-10320.FINAL State Instructions and Instrument.pdf Form and Instruction
CMS-10320 State instructions and instruments CMS-10320.FINAL State Instructions and Instrument.pdf Form and Instruction
CMS 10320 Appendix G_2020 .xlsm Data Collection Template IC Document
CMS 10320 Appendix G_2020 .xlsm Data Collection Template IC Document

Information Collection (IC) Details

IC Title:	States - Data Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10320	State instructions and instruments	CMS-10320.FINAL State Instructions and Instrument.pdf		No		Paper Only
Instruction			CMS-10320 Appendix_E_State 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: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Data Collection Template	CMS 10320 Appendix G_2020 .xlsm	01/28/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.