Information Collection Request
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 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1193 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10439 SHOP - Employer |
Form and Instruction | Modified | Repair queued |
 CMS-10439 - Supporting Statement -30day.docx |
Supporting Statement A | Uploaded 2023-01-27 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 205691 |  SHOP - Employer |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1193 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 201908-0938-013 |
| Agency Tracking No | CCIIO |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |