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

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