Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Health Benefits Exchanges, Medicaid and CHIP Agencies (CMS-10440)
ICR 202208-0938-007
OMB: 0938-1191
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1191 can be found here:
Data Collection to Support
Eligibility Determinations for Insurance Affordability Programs and
Enrollment through Health Benefits Exchanges, Medicaid and CHIP
Agencies (CMS-10440)
Revision of a currently approved collection
No
Regular
08/05/2022
Requested
Previously Approved
36 Months From Approved
09/30/2022
4,884,000
4,662,000
2,205,614
946,386
0
0
Section 1413 of the Affordable Care
Act directs the Secretary of HHS to develop and provide to each
State a single, streamlined form that may be used to apply for
coverage through the Exchange and Insurance Affordability Programs.
A state may develop and use its own single streamlined application
if approved by the Secretary in accordance with section 1413 and if
it meets the standards established by the Secretary.
The burden has increased due to
an increase in the number of respondents and the correction of an
arithmetic error in the burden calculation from the last submission
cycle.
$298,100
No
No
No
Yes
No
No
No
Jamaa Hill 301 492-4190
No
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.