Web-broker Website Required QHP Comparative Information and Enrollment Support Disclaimer

Supporting Statement for Direct Enrollment Entities (CMS-10877)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1463 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	Web-broker Website Required QHP Comparative Information and Enrollment Support Disclaimer	Agency IC Tracking Number:	CCIIO - 10877

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.220(c)(3)(i)(A)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	40,020	40,020

Documents for IC

Title	Document	Date Uploaded
No associated records found

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