Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment (CMS-10468)
ICR 202604-0938-004
OMB: 0938-1207
Federal Form Document
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Essential Health Benefits in
Alternative Benefit Plans, Eligibility Notices, Fair Hearing and
Appeal Processes, and Premiums and Cost Sharing; Exchanges:
Eligibility and Enrollment (CMS-10468)
Reinstatement without change of a previously approved
collection
No
Regular
04/10/2026
Requested
Previously Approved
36 Months From Approved
1,140
0
25,614
0
2,955,530
0
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”),
expands access to health insurance for individuals and employees of
small businesses through the establishment of new Affordable
Insurance Exchanges (Exchanges), including the Small Business
Health Options Program (SHOP). The Exchanges, which became
operational on January 1, 2014, enhanced competition in the health
insurance market, expanded access to affordable health insurance
for millions of Americans, and provided consumers with a place to
easily compare and shop for health insurance coverage. Benefit
Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and
Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment
(CMS-2334-F) address: (1) standards related to notices, (2)
procedures for the verification of enrollment in an eligible
employer-sponsored plan and eligibility for qualifying coverage in
an eligible employer-sponsored plan; and (3) other eligibility and
enrollment provisions to provide detail necessary for state
implementation. The submission seeks OMB approval of the
information collection requirements Sections 1311(b) and 1321(b) of
the Affordable Care Act provide that each state has the opportunity
to establish an Exchange that (1) facilitates the purchase of
insurance coverage by qualified individuals through QHPs; (2)
assists qualified employers in the enrollment of their employees in
QHPs; and (3) meets other standards specified in the Affordable
Care Act. Section 1311(k) of the Affordable Care Act specifies that
Exchanges may not establish rules that conflict with or prevent the
application of regulations promulgated by the Secretary. Section
1311(d) of the Affordable Care Act describes the minimum functions
of an Exchange, including the certification of QHPs.
US Code: 45 USC 155.315 Name of Law:
Verification process related to eligibility for enrollment in a QHP
through the Exchange
US Code: 45 USC 155.320 Name of Law: Verification process related
to eligibility for insurance affordability programs
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:
(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;
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.
04/10/2026
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Subpart D-Exchange Functions in the Individual Market: Eligibility Determinations for Exchange Participation and Insurance Affordability