State Based Marketplace Data Collection Templates for Bi-Annual Reporting

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

OMB: 0938-1119

IC ID: 252604

Information Collection (IC) Details

View Information Collection (IC)

State Based Marketplace Data Collection Templates for Bi-Annual Reporting
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Data Template CMS-10371 - Cooperative Agreement Bi-Annual Metrics 30-day Final.docx Yes Yes Paper Only

Health Health Care Services

 

18 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 36 0 0 36 0 0
Annual IC Time Burden (Hours) 369 0 0 369 0 0
Annual IC Cost Burden (Dollars) 1,251,236 0 0 1,251,236 0 0

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

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