SBM Individual Market Reports (weekly)

Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges (CMS-10371)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1119 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10371 SBM Individual Market Reports (weekly) Form and Instruction
CMS-10371 SBM Individual Market Reporting CMS-10371 - Cooperative Agreement Weekly Metrics 30-day final.docx Form and Instruction
CMS-10371 SBM Individual Market Reporting CMS-10371 - Cooperative Agreement Weekly Metrics 30-day final.docx Form and Instruction

Information Collection (IC) Details

IC Title:	SBM Individual Market Reports (weekly)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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-10371	SBM Individual Market Reporting	CMS-10371 - Cooperative Agreement Weekly Metrics 30-day final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

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	198	-18	216
Annual IC Time Burden (Hours)	1,931	-4,419	6,350
Annual IC Cost Burden (Dollars)	0	0	0

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.