155.225(b)(1) (organization designation by Exchange)

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

OMB: 0938-1205

IC ID: 207872

Information Collection (IC) Details

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155.225(b)(1) (organization designation by Exchange)
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
45 CFR 155.225(b)(1)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10494 Individual CAC Agreement CMS-10494 - Appendix G_Individual CAC Agreement.docx Yes Yes Fillable Fileable

Health Health Care Services

 

5,000 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   80 %

  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 5,000 0 0 0 0 5,000
Annual IC Time Burden (Hours) 5,000 0 0 0 0 5,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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