Data Collection to Support Eligibility Determinations and Enrollment for Small Businesses in the Small Business Health Options Program (CMS-10439)

ICR 202301-0938-019

OMB: 0938-1193

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10439 SHOP - Employer Form and Instruction	Modified
CMS-10439 - Supporting Statement -30day.docx Supporting Statement A	2023-01-27

IC Document Collections

IC ID	Document Title	Status
205691	SHOP - Employer Form and Instruction	Modified