Information Collection Request

Supporting Statement for Agent/Broker Consent Information Collection (CMS-10840)

ICR 202412-0938-007 · OMB 0938-1438 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10840 Agent Broker Consent Form Form and Instruction Modified Available
Form CMS-10840 Agent/Broker Eligibility and Consent Records Form and Instruction Modified Repair queued
Form CMS-10840 CMS Model Consent Form for Marketplace Agents and Brokers Form Modified Available
Form CMS-10840 Agent/Broker Eligibility and Consent Documentation Form Modified Repair queued
CMS-10840_Agent-Broker_Consent_Supporting_Statementf.docx Supporting Statement A Uploaded 2024-12-10 Repair queued
CMS-10840_Agent-Broker_Consent_Supporting_Statementf.docx Supporting Statement A Uploaded 2024-12-10 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
259918 Agent/Broker Eligibility and Consent Records Form and Instruction ModifiedAgent Broker Consent Form
259918 Agent/Broker Eligibility and Consent Records Form and Instruction Modified
257714 Agent/Broker Eligibility and Consent Documentation Form ModifiedCMS Model Consent Form for Marketplace Agents and Brokers
257714 Agent/Broker Eligibility and Consent Documentation Form Modified

ICR Details

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table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2026 36 Months From Approved 06/30/2026
4,948,029 0 4,948,029
841,385 0 841,385
26,388,358 0 26,388,358





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2
table that charts list of burden
IC Title Form No. Form Name
Agent/Broker Eligibility and Consent Documentation CMS-10840
Agent/Broker Eligibility and Consent Records CMS-10840



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  No