Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Health Benefits Exchanges, Medicaid and CHIP Agencies (CMS-10440)
ICR 202504-0938-017 · OMB 0938-1191 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1191 can be found here:
Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Health Benefits Exchanges, Medicaid and CHIP Agencies (CMS-10440)
No material or nonsubstantive change to a currently approved collection
Prior to the next extension or revision of this ICR, the public burden statement on each instrument shall be updated to include language that provides all of the information required per 5 CFR § 1320.8(b)(3).
Inventory as of this Action
Requested
Previously Approved
09/30/2027
09/30/2027
09/30/2027
11,327,040
0
11,327,040
7,105,452
0
7,105,452
0
0
0
Section 1413 of the Affordable Care Act directs the Secretary of HHS to develop and provide to each State a single, streamlined form that may be used to apply for coverage through the Exchange and Insurance Affordability Programs. A state may develop and use its own single streamlined application if approved by the Secretary in accordance with section 1413 and if it meets the standards established by the Secretary.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Individual Application