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

Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment (CMS-10468)

Documents and Forms

Document Name Document Type
CMS-10468 - Appendix A - Data Elementsfr.pdf Other-Data Elements
CMS-10468 - Appendix A - Data Elementsfr.pdf Other-Data Elements

Information Collection (IC) Details

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:

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 %

	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

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.