Information Collection

Quarterly Progress Reports

IC 208329 under ICR 202202-0938-001 · OMB 0938-1215.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-10463 - Navigator Reporting Requirements.pdf Reporting Requirements	IC Document
CMS-10463 - Navigator Reporting Requirements.pdf Reporting Requirements	IC Document

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	400	200	200
Annual IC Time Burden (Hours)	200	100	100
Annual IC Cost Burden (Dollars)	2,352,800	1,176,400	1,176,400

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Reporting Requirements	CMS-10463 - Navigator Reporting Requirements.pdf	02/02/2022

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