Information Collection

Subpart D-Exchange Functions in the Individual Market: Eligibility Determinations for Exchange Participation and Insurance Affordability

IC 207762 under ICR 202205-0938-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Elementsfr.pdf	Other-Data Elements
CMS-10468 - Appendix A - Data Elementsfr.pdf	Other-Data Elements

IC Title:

Subpart D-Exchange Functions in the Individual Market: Eligibility Determinations for Exchange Participation and Insurance Affordability

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 155.302 45 CFR 155.345

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 Elementsfr.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,082

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
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,082	1,069	13
Annual IC Time Burden (Hours)	24,354	24,267	87
Annual IC Cost Burden (Dollars)	2,827,266	2,826,447	819

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.