Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges (CMS-10416)

ICR 202508-0938-025

OMB: 0938-1172

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10416 Exchange Blueprint Application Form and Instruction	Modified
PRA Cross-Walk_Blueprint 2025.docx Supplementary Document	2025-08-29
CMS-10416 - Blueprint Supporting Statement (Clean).docx Supporting Statement A	2025-08-29

IC Document Collections

IC ID	Document Title	Status
202391	Exchange Blueprint Application Form and Instruction	Modified