Information Collection Request
Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges (CMS-10371)
ICR 202404-0938-009 · OMB 0938-1119 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1119 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10371 SBM Three-year Budget Reports |
Form and Instruction | Unchanged | Available |
| Form CMS-10371 SBM Three-year Budget Reports |
Form and Instruction | Unchanged | Repair queued |
| Form CMS-10371 SBM Individual Market Reports (weekly) |
Form and Instruction | Unchanged | Available |
| Form CMS-10371 SBM Individual Market Reports (weekly) |
Form and Instruction | Unchanged | Repair queued |
 SBEBudgetTemplate2024_Redline.xls |
Supplementary Document | Uploaded 2024-04-11 | Available |
| SBEBudgetTemplate2024_Redline.xls |
Supplementary Document | Uploaded 2024-04-11 | Repair queued |
| SBEBudgetTemplate2024.xls |
Supplementary Document | Uploaded 2024-04-11 | Available |
| SBEBudgetTemplate2024.xls |
Supplementary Document | Uploaded 2024-04-11 | Missing upstream |
 0938-1119 Non-sub Change Request Memo_clean.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-04-11 | Available |
| 0938-1119 Non-sub Change Request Memo_clean.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-04-11 | Missing upstream |
| CMS-10371 - Cooperative Agreement Weekly Metrics - Final.docx |
Supplementary Document | Uploaded 2023-03-06 | Available |
| CMS-10371 - Cooperative Agreement Weekly Metrics - Final.docx |
Supplementary Document | Uploaded 2023-03-06 | Missing upstream |
| CMS-10371 - Cooperative Agreement Weekly Metrics redlined.docx |
Supplementary Document | Uploaded 2023-03-06 | Available |
| CMS-10371 - Cooperative Agreement Weekly Metrics redlined.docx |
Supplementary Document | Uploaded 2023-03-06 | Missing upstream |
| 0938-1119 Change Request - Justification (003).docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-03-10 | Available |
| 0938-1119 Change Request - Justification (003).docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-03-10 | Repair queued |
| CMS-10371 - Cooperative Agreement Supporting Statement (F).docx |
Supporting Statement A | Uploaded 2022-04-08 | Available |
| CMS-10371 - Cooperative Agreement Supporting Statement (F).docx |
Supporting Statement A | Uploaded 2022-04-08 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 252604 |  State Based Marketplace Data Collection Templates for Bi-Annual Reporting |
Other-Data Template | Unchanged | |
| 228022 | SBM Three-year Budget Reports |
Form and Instruction | Unchanged | |
| 228022 | SBM Three-year Budget Reports |
Form and Instruction | Unchanged | |
| 228019 | SBM Individual Market Reports (weekly) |
Form and Instruction | Unchanged | |
| 228019 | SBM Individual Market Reports (weekly) |
Form and Instruction | Unchanged | |
| 216248 | End of Enrollment Budget Report |
Other-Data Elements | Unchanged |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1119 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202302-0938-016 |
| Agency Tracking No | CCIIO |
| Date Submitted to OIRA | 2024-04-11 |
| Requested Expiration Date | 1969-12-31 |