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Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Health Benefits Exchanges, Medicaid and CHIP Agencies (CMS-10440)
ICR 202507-0938-012
OMB: 0938-1191
Federal Form Document
OMB.report
HHS/CMS
OMB 0938-1191
ICR 202507-0938-012
( )
Forms and Documents
Document
Name
Status
Form CMS-10440 Individual Application
Form and Instruction
Modified
CMS-10440 Supporting Statement Final.docx
Supporting Statement A
2025-07-08
Att A.-Application PRA Electronic Application 022825 Clean.xlsx
Supplementary Document
2025-06-04
IC Document Collections
IC ID
Document
Title
Status
205692
Individual Application
Form and Instruction
Modified
ICR Details
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