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
Forms and Documents
| 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 | Missing upstream |
| Form CMS-10492 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs) |
Form and Instruction | Modified | Repair queued |
 CMS-10492 - User Fee Adjustment Supporting Statement - 2223.docx |
Supporting Statement A | Uploaded 2023-02-02 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 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 |
ICR Details
| 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 |