Supporting Statement for Agent/Broker Consent Information Collection (CMS-10840)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10840 Agent Broker Consent Form	Form and Instruction	Modified	Available
Form CMS-10840 CMS Model Consent Form	Form	Modified	Available
CMS-10840 - Supporting Statement.docx	Supporting Statement A	Uploaded 2026-02-11	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
279055	Burden to Respond to Misleading Marketing		New
259918	Agent/Broker Eligibility and Consent Records	Form and Instruction	Modified	Agent Broker Consent Form
259918	Agent/Broker Eligibility and Consent Records	Form and Instruction	Modified
257714	Agent/Broker Eligibility and Consent Documentation	Form	Modified	CMS Model Consent Form
257714	Agent/Broker Eligibility and Consent Documentation	Form	Modified

ICR Details

OMB Control No: 0938-1438	ICR Reference No: 202602-0938-011
Status: Received in OIRA	Previous ICR Reference No: 202501-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Supporting Statement for Agent/Broker Consent Information Collection (CMS-10840)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/27/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2028
Responses	9,800,624	9,800,600
Time Burden (Hours)	1,666,624	1,666,601
Cost Burden (Dollars)	52,269,473	52,268,080

---

Abstract: The Patient Protection and Affordable Care Act, Public Law 111-148, enacted on March 23, 2010, and the Health Care and Education Reconciliation Act, Public Law 111-152, enacted on March 30, 2010 (collectively, “Affordable Care Act”), expanded access to health insurance for individuals and employees of small businesses through the establishment of new Affordable Insurance Exchanges (Exchanges), also called Marketplaces. The Exchanges, which became operational on January 1, 2014, enhance competition in the health insurance market, expand access to affordable health insurance for millions of Americans, and provide consumers with a place to easily compare and shop for health insurance coverage. Section 1312(e) of the Affordable Care Act directs the Secretary of the Department of Health and Human Services (HHS) to establish procedures under which a state may permit agents and brokers to enroll qualified individuals and employers into qualified health plans (QHPs) offered through an Exchange and to enable these agents and brokers to assist individuals in applying for advance payments of the premium tax credit and cost-sharing reductions. Authority for collection of this information comes from 45 C.F.R. §155.220(c)(5), which states that “HHS or its designee may periodically monitor and audit an agent, broker, or web-broker under this subpart to assess its compliance with the applicable requirements of this section.” This information collection specifically details what information will be required to be collected and maintained by agents, brokers, and web-brokers were they to receive a request from HHS for consent records. Currently, HHS only plans to collect information from a small percentage of agents, brokers, or web-brokers in conjunction with active investigations of potential fraud. Utilizing §155.220(c)(5) and the information to be collected under newly proposed §§ 155.220(j)(2)(ii)(A)(1-2) and 155.220(j)(2)(iii)(A-C), HHS will be able to verify whether or not an agent, broker, or web-broker has obtained consent from a consumer they are assisting in enrolling in coverage in the individual market, and whether the consumer has reviewed their eligibility information and confirmed its accuracy.

---

Authorizing Statute(s): US Code: 45 USC 155.220 Name of Law: Exchange Establishment Standards and Other Related Standards under the Affordable Care Act
   PL: Pub.L. 111 - 148 1312 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: US Code: 45 USC 155.220 Name of Law: Exchange Establishment Standards and Other Related Standards under the Affordable Care Act
PL: Pub.L. 111 - 148 1312 Name of Law: Patient Protection and Affordable Care Act

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV62	Proposed rulemaking	91 FR 6292	02/11/2026

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Agent/Broker Eligibility and Consent Documentation	CMS-10840	CMS Model Consent Form
Agent/Broker Eligibility and Consent Records	CMS-10840	Agent Broker Consent Form
Burden to Respond to Misleading Marketing

---

ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	9,800,624	9,800,600	0	0	24	0
Annual Time Burden (Hours)	1,666,624	1,666,601	0	-1	24	0
Annual Cost Burden (Dollars)	52,269,473	52,268,080	0	0	1,393	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There is an overall increase in the financial burden from the 2025 PRA package. There is no change in the number of agents, brokers, or web-brokers required to use the HHS-mandated model consent form to meet the eligibility application review requirements and the consumer consent documentation requirements. There is no change in the number of policies submitted by agents. There is a small increase in burden due to the new proposed activity of responding to HHS requests to provide compliant marketing. Lastly, an increase in labor costs also contributed to the increase in burden costs. The total annual burden hours increased from 1,666,600 to 1,666,624, which is an increase of 24 hours. The estimated annual cost increased from $94,702,080 to $96,762,217, which is an increase of $2,060,137.

---

Annual Cost to Federal Government: $72,638

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/27/2026

---