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Federal forms, ICRs, and supporting documents

Information Collection

Agents/Broker Data Collection in Federally Facilitated Health Insurance Exchanges

IC 207074 under ICR 202511-0938-013 · OMB 0938-1204.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Agents/Broker Data Collection in Federally Facilitated Health Insurance Exchanges
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 155.220

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10464 Agent-Broker Appendix A Screenshot CMS-10464 - Appendix - A - Screenshots.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

100,000 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100,000 0 0 36,000 64,000 0
Annual IC Time Burden (Hours) 12,000 0 0 -3,360 15,360 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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