Information Collection

Subpart C-General Functions of an Exchange

IC 207761 under ICR 202201-0938-012 · OMB 0938-1207.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-10468 - Appendix A - Data Elements.pdf	Other-Data elements
CMS-10468 - Appendix A - Data Elements.pdf	Other-Data elements

IC Title:

Subpart C-General Functions of an Exchange

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 155.227

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data elements			CMS-10468 - Appendix A - Data Elements.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	18	5	13
Annual IC Time Burden (Hours)	540	-98,996	99,536
Annual IC Cost Burden (Dollars)	57,024	-359,291	416,315

Documents for IC

table that charts IC Documents
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.