OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel - CAC (CMS-10494)

ICR 202210-0938-013 · OMB 0938-1205 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-10494 Navigator Requirements for Training Certification Form and Instruction Unchanged Available
Form CMS-10494 Certified Counselor Designated Organization (CDO Application) Form and Instruction Unchanged Repair queued
Form CMS-10494 Recertification request by organization Form and Instruction Unchanged Repair queued
Form CMS-10494 155.225(b)(1) Organization designation by Exchange Information Updates Form and Instruction Unchanged Repair queued
Form CMS-10494 155.225(d)(1) and (7) Training Quality Optional Questionnaire Form and Instruction Unchanged Repair queued
Form CMS-10494 155.225(d)(1) - Training certificate retention Form and Instruction Unchanged Repair queued
Form CMS-10494 155.225(d)(1) - Training certificate proof Form and Instruction Unchanged Repair queued
Form CMS-10494 155.225(d)(1) - Training Registration Form and Instruction Unchanged Repair queued
Form CMS-10494 155.225(b)(1)(ii) - Identification number record retention Form and Instruction Unchanged Repair queued
Form CMS-10494 155.225(b)(1)(ii) - Issuance of unique registration identification number Form and Instruction Unchanged Repair queued
Form CMS-10494 155.225(d)(2) and (f) (CAC authorization to consumer) Form and Instruction Unchanged Repair queued
Form CMS-10494 155.225(b)(1)(i) (certificate issuance) Form and Instruction Unchanged Repair queued
Form CMS-10494 155.225(b)(1) (organization follow-up for application) Form and Instruction Unchanged Repair queued
Form CMS-10494 155.225(b)(1) (organization designation by Exchange) Form and Instruction Unchanged Repair queued
CMS-10494 - Conflict of Interest Disclosure_ CAC).pdf Supplementary Document Uploaded 2022-10-25 Repair queued
CMS-10494 - Non Substantive Change Request 508.pdf Justification for No Material/Nonsubstantive Change Uploaded 2022-10-25 Repair queued
CMS-10494 - Supporting_Statement_March 2022.docx Supporting Statement A Uploaded 2022-03-02 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
251934 Navigator Requirements for Training Certification Form and Instruction Unchanged
241050 Certified Counselor Designated Organization (CDO Application) Form and Instruction Unchanged
220357 ?155.225 (b)(ii) (performance tracking form by organization) Unchanged
220355 ?155.225 (b)(ii) (reporting performance data by certified application counselor) Unchanged
220354 ?155.225 (b)(ii) (recordkeeping performance data by organization) Unchanged
220353 ?155.225 (b)(1)(iii)- (reporting by organizations) Unchanged
220352 ?155.225 (b)(1)(iii)- (review by State Exchange) Unchanged
220351 ?155.225(b)(1)(iii)-(review byFederally-facilitatedExchange) Unchanged
216275 Recertification Training Unchanged
216274 Recertification request by organization Form and Instruction Unchanged
216273 CAC Recertification Unchanged
216272 155.225(b)(1) Organization designation by Exchange Information Updates Form and Instruction Unchanged
216271 155.225(d)(1) and (7) Training Quality Optional Questionnaire Form and Instruction Unchanged
208217 155.225(d)(1) - Training certificate retention Form and Instruction Unchanged
208216 155.225(d)(1) - Training certificate proof Form and Instruction Unchanged
208215 155.225(d)(1) - Training Registration Form and Instruction Unchanged
208214 155.225(b)(1)(ii) - Identification number record retention Form and Instruction Unchanged
208213 155.225(b)(1)(ii) - Issuance of unique registration identification number Form and Instruction Unchanged
207940 155.225(d)(2) and (f) (CAC authorization to consumer) Form and Instruction Unchanged
207939 155.225(d)(2) and (f) (organization record of authorization) Unchanged
207938 155.225(b)(1)(i) (certificate issuance) Form and Instruction Unchanged
207937 155.225(b)(1) (organization list) Unchanged
207874 155.225(b)(1)(i) (organization attestation) Unchanged
207873 155.225(b)(1) (organization follow-up for application) Form and Instruction Unchanged
207872 155.225(b)(1) (organization designation by Exchange) Form and Instruction Unchanged
ICR Details
StatusReceived in OIRA
Agency/SubagencyHHS/CMS
OMB Control No0938-1205
Type of Information CollectionNo material or nonsubstantive change to a currently approved collection
Previous ICR Reference No202110-0938-014
Agency Tracking NoCCIIO - 10494
Date Submitted to OIRA1969-12-31
Requested Expiration Date1969-12-31