Information Collection Request

Supporting Statement for Direct Enrollment Entities (CMS-10877)

ICR 202311-0938-002 · OMB 0938-1463 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10877 INTERCONNECTION SECURITY AGREEMENT Form New Available
Form CMS-10877 Business Agreement BY 2024 Form and Instruction New Available
Form CMS-10877 Change Notification Form Form and Instruction New Available
Form CMS-10877 Eligibility Results Toolkit - Phase 3 Form and Instruction New Available
Form CMS-10877 Eligibility Results Toolkit - Phase 2 Form and Instruction New Available
Form CMS-10877 Eligibility Results Toolkit Form and Instruction New Available
Form CMS-10877 Communications Toolkit Form and Instruction New Available
Form CMS-10877 Application User Interface Toolkit Form and Instruction New Available
Form CMS-10877 Privacy Questiionaire Form and Instruction New Available
Form CMS-10877 Documentation and Audit Package Form and Instruction New Available
Form CMS-10877 DE Entity Operational Readiness Review (ORR) Form and Instruction New Repair queued
Form CMS-10877 System Security and Privacy Plans (SSPs) workbook Form and Instruction New Available
Form CMS-10877 Plans of Action and Milestones (POA&Ms) template Form and Instruction New Available
Form CMS-10877 Security and Privacy Assessment Reports (SARs) template Form and Instruction New Available
Form CMS-10877 Web-Broker Agreement Form and Instruction New Available
Form CMS-10877 Web-broker Operational Readiness Reviews (ORR) Form and Instruction New Repair queued
CMS-10877 - Direct_Enrollment_Entities_Supporting_Statement.docx Supporting Statement A Uploaded 2023-11-07 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
263481 Web-brokers to Prominently Display Consumer Eligibility Results for Advance Payments of the Premium Tax Credit and Cost-sharing Reductions New
263480 Application to State Exchanges New
263478 Web-brokers to Implement Application to State Exchanges New
263477 Direct Enrollment Entities to Implement Application Assister Requirements New
263476 Web-Brokers to Provide the State Exchange a List of Agents or Brokers New
263474 DE Entity Web-brokers and QHP Issuers to Implement Mandate for HealthCare.gov website Changes New
263473 Issuers to Implement Website Display Requirements for QHPs New
263471 Direct Enrollment Entities to Implement Third-Party Entity Contractual Requirements New
263333 Direct Enrollment Entity Separate Plan Display Exception Requirement New
263332 DE Entities to Implement Separate Plan Display Requirement New
263331 Web-brokers to Implement the General non-FFE Disclaimer Requirement New
263330 DE Entities to Implement the Standardized Disclaimer Requirement New
263329 Web-broker Website Explanation of Rationale for QHP Recommendations and Methodology for Default Display New
263328 Web-broker Website Required QHP Comparative Information and Enrollment Support Disclaimer New
263264 DE Entity Operational Readiness Review (ORR) Form NewINTERCONNECTION SECURITY AGREEMENT
263264 DE Entity Operational Readiness Review (ORR) Form and Instruction NewBusiness Agreement BY 2024
263264 DE Entity Operational Readiness Review (ORR) Form and Instruction NewChange Notification Form
263264 DE Entity Operational Readiness Review (ORR) Form and Instruction NewEligibility Results Toolkit - Phase 3
263264 DE Entity Operational Readiness Review (ORR) Form and Instruction NewEligibility Results Toolkit - Phase 2
263264 DE Entity Operational Readiness Review (ORR) Form and Instruction NewEligibility Results Toolkit
263264 DE Entity Operational Readiness Review (ORR) Form and Instruction NewCommunications Toolkit
263264 DE Entity Operational Readiness Review (ORR) Form and Instruction NewApplication User Interface Toolkit
263264 DE Entity Operational Readiness Review (ORR) Form and Instruction NewPrivacy Questiionaire
263264 DE Entity Operational Readiness Review (ORR) Form and Instruction NewDocumentation and Audit Package
263264 DE Entity Operational Readiness Review (ORR) Form and Instruction New
263264 DE Entity Operational Readiness Review (ORR) Instruction New
263263 Web-broker Operational Readiness Reviews (ORR) Form and Instruction NewSystem Security and Privacy Plans (SSPs) workbook
263263 Web-broker Operational Readiness Reviews (ORR) Form and Instruction NewPlans of Action and Milestones (POA&Ms) template
263263 Web-broker Operational Readiness Reviews (ORR) Form and Instruction NewSecurity and Privacy Assessment Reports (SARs) template
263263 Web-broker Operational Readiness Reviews (ORR) Form and Instruction NewWeb-Broker Agreement
263263 Web-broker Operational Readiness Reviews (ORR) Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
36 Months From Approved
0 0 0
0 0 0
0 0 0





Reginfo record details
16
table that charts list of burden
IC Title Form No. Form Name
Application to State Exchanges
DE Entities to Implement Separate Plan Display Requirement
DE Entities to Implement the Standardized Disclaimer Requirement
DE Entity Operational Readiness Review (ORR) CMS-10877, CMS-10877, CMS-10877, CMS-10877, CMS-10877, CMS-10877, CMS-10877, CMS-10877, CMS-10877, CMS-10877 ,   ,   ,   ,   ,   ,   ,   ,   ,  
DE Entity Web-brokers and QHP Issuers to Implement Mandate for HealthCare.gov website Changes
Direct Enrollment Entities to Implement Application Assister Requirements
Direct Enrollment Entities to Implement Third-Party Entity Contractual Requirements
Direct Enrollment Entity Separate Plan Display Exception Requirement
Issuers to Implement Website Display Requirements for QHPs
Web-Brokers to Provide the State Exchange a List of Agents or Brokers
Web-broker Operational Readiness Reviews (ORR) CMS-10877, CMS-10877, CMS-10877, CMS-10877 ,   ,   ,  
Web-broker Website Explanation of Rationale for QHP Recommendations and Methodology for Default Display
Web-broker Website Required QHP Comparative Information and Enrollment Support Disclaimer
Web-brokers to Implement Application to State Exchanges
Web-brokers to Implement the General non-FFE Disclaimer Requirement
Web-brokers to Prominently Display Consumer Eligibility Results for Advance Payments of the Premium Tax Credit and Cost-sharing Reductions



Reginfo record details
  No