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End of Enrollment Budget Report
Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges (CMS-10371)
OMB: 0938-1119
IC ID: 216248
OMB.report
HHS/CMS
OMB 0938-1119
ICR 202404-0938-009
IC 216248
( )
Documents and Forms
Document Name
Document Type
CMS-10371 - Performance_Review-Data_Elements.pdf
Other-Data Elements
CMS-10371 - Performance_Review-Data_Elements.pdf
Other-Data Elements
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
End of Enrollment Budget Report
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Data Elements
CMS-10371 - Performance_Review-Data_Elements.pdf
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
18
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
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
18
0
0
0
0
18
Annual IC Time Burden (Hours)
185
0
0
0
0
185
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
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.