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Federal forms, ICRs, and supporting documents

Information Collection

Web-broker Operational Readiness Reviews (ORR)

IC 263263 under ICR 202311-0938-002 · OMB 0938-1463.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Web-broker Operational Readiness Reviews (ORR) CCIIO - 10877
 
No New
 
Required to Obtain or Retain Benefits
 
45 CFR 155.205, 220-221 45 CFR 156.1230

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10877 Web-Broker Agreement CMS-10877 - Appendix_A_Web-broker_Agreement.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10877 Security and Privacy Assessment Reports (SARs) template CMS-10877 - Appendix_B_NEE-EDE-SAR-Template.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10877 Plans of Action and Milestones (POA&Ms) template CMS-10877 - Appendix_C_NEE-POA&M-Template.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10877 System Security and Privacy Plans (SSPs) workbook CMS-10877 - Appendix_D_NEE-EDE-SSP-Workbook.pdf Yes No Paper Only

Health Health Care Services

 

20 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 20 20 0 0 0 0
Annual IC Time Burden (Hours) 380 380 0 0 0 0
Annual IC Cost Burden (Dollars) 27,786 27,786 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.