Information Collection Request
Disclosure of State Rating Requirements and Individual Market Special Enrollment Notice (CMS-10454)
ICR 202212-0938-001 · OMB 0938-1258 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1258 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10454 Disclosure of State Rating Requirements |
Form and Instruction | Unchanged | Repair queued |
 CMS-10454 - Non-Sub Change Request 2022.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2022-12-01 | Repair queued |
| CMS-10454 Supporting Statementf - Part A -.docx |
Supporting Statement A | Uploaded 2021-03-18 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 208568 |  Disclosure of State Rating Requirements |
Form and Instruction | Unchanged |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1258 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202103-0938-016 |
| Agency Tracking No | CCIIO - 10454 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |