Exemption Applications - Eligibility for Exemptions

Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions (CMS-10466)

OMB: 0938-1190

IC ID: 205753

Information Collection (IC) Details

View Information Collection (IC)

Exemption Applications - Eligibility for Exemptions
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 155.620 45 CFR 155.610 45 CFR 155.615 45 CFR 155.625

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10466 Application Exemptions Shared Responsibility for FFM's Appendix C - Affordability-SBE-Exemptions-Application.pdf Yes No Fillable Printable
Form and Instruction CMS-10466 Exemption Application - Shared Responsibility SBM's Appendix B - Affordability-FFM-Exemption-Application.pdf Yes No Fillable Printable
Form and Instruction CMS-10466 Application Exemption - Hardships Appendix A - Hardship-Exemption-Application (2).pdf Yes No Fillable Printable

Health Health Care Services

 

849 0
   
Individuals or Households
 
   90 %

  Approved 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 849 0 0 -44,151 0 45,000
Annual IC Time Burden (Hours) 229 0 0 -11,921 0 12,150
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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