Information Collection Request

State-based Marketplace Annual Reporting Tool (SMART) (CMS-10507)

ICR 202604-0938-024 · OMB 0938-1244 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10507 SMART SBE Annual Alternative Redeterminations Template Form and Instruction Modified Available
Form CMS-10507 SMART Tool Form and Instruction Modified Available
CMS-10507 - Appendix A - Changes to SMART.docx Supplementary Document Uploaded 2026-04-30 Available
PRA Cross-Walk - SMART 2026.docx Supplementary Document Uploaded 2026-04-30 Available
CMS-10507SupportingStatementA.docx Supporting Statement A Uploaded 2026-04-30 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
254986 SMART SBE Annual Alternative Redeterninations Template Form and Instruction ModifiedSMART SBE Annual Alternative Redeterminations Template
210245 State-based Marketplace Annual Reporting Tool (SMART) Form and Instruction ModifiedSMART Tool

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved
23 0
4,792 0
0 0





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2
table that charts list of burden
IC Title Form No. Form Name
SMART SBE Annual Alternative Redeterninations Template CMS-10507
State-based Marketplace Annual Reporting Tool (SMART) CMS-10507

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 23 0 0 0 2 21
Annual Time Burden (Hours) 4,792 0 0 0 511 4,281
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No