Information Collection Request

Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment (CMS-10492)

ICR 202302-0938-001 · OMB 0938-1285 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1285 can be found here:

Forms and Documents

Forms and supporting documents for this ICR
Document	Type	Status	Availability
Form CMS-10492 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)	Form and Instruction	Modified	Repair queued
Form CMS-10492 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer)	Form and Instruction	Modified	Available
Form CMS-10492 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs)	Form and Instruction	Modified	Missing upstream
CMS-10492 - User Fee Adjustment Supporting Statement - 2223.docx	Supporting Statement A	Uploaded 2023-02-02	Repair queued

Information collection document groups
IC ID	Collection	Type	Status
258236	Data Submission and Maintenance of Records for Individual Contraceptive Arrangement		New
258183	Collection of User Fee Adjustment Information from FFE (or SBE-FP) Participating Issuers	Instruction	New
217425	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)	Form and Instruction	Modified
217424	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer)	Form and Instruction	Modified
217422	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs)	Form and Instruction	Modified

Record metadata
Status	Received in OIRA
Agency/Subagency	HHS/CMS
OMB Control No	0938-1285
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202208-0938-009
Agency Tracking No	CCIIO
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31