Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges (CMS-10371)

OMB 0938-1119

Information collected as a part of the application for this grant will be used to evaluate the applications and determine awardees. Information collected pursuant to the reporting requirements for awardees will be used to evaluate the progress of States in planning for and implementing Exchanges, and determine how the Secretary can provide assistance to achieve the goals of the grant program and the Affordable Care Act.

The latest form for Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges (CMS-10371) expires 2020-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10371 SBM Three-year Budget Reports Form and Instruction
Form CMS-10371 SBM Three-year Budget Reports Form and Instruction
Form CMS-10371 SBM Individual Market Reports (weekly) Form and Instruction
Form CMS-10371 SBM Individual Market Reports (weekly) Form and Instruction
SBEBudgetTemplate2024_Redline.xls Supplementary Document
SBEBudgetTemplate2024_Redline.xls Supplementary Document
SBEBudgetTemplate2024.xls Supplementary Document
SBEBudgetTemplate2024.xls Supplementary Document
0938-1119 Non-sub Change Request Memo_clean.docx Justification for No Material/Nonsubstantive Change
0938-1119 Non-sub Change Request Memo_clean.docx Justification for No Material/Nonsubstantive Change
CMS-10371 - Cooperative Agreement Weekly Metrics - Final.docx Supplementary Document
CMS-10371 - Cooperative Agreement Weekly Metrics - Final.docx Supplementary Document
CMS-10371 - Cooperative Agreement Weekly Metrics redlined.docx Supplementary Document
CMS-10371 - Cooperative Agreement Weekly Metrics redlined.docx Supplementary Document
0938-1119 Change Request - Justification (003).docx Justification for No Material/Nonsubstantive Change
0938-1119 Change Request - Justification (003).docx Justification for No Material/Nonsubstantive Change
CMS-10371 - Cooperative Agreement Supporting Statement (F).docx Supporting Statement A
CMS-10371 - Cooperative Agreement Supporting Statement (F).docx Supporting Statement A
State Based Marketplace Data Collection Templates for Bi-Annual Reporting Other-Data Template
SBM Three-year Budget Reports Form and Instruction
SBM Three-year Budget Reports Form and Instruction
SBM Individual Market Reports (weekly) Form and Instruction
SBM Individual Market Reports (weekly) Form and Instruction
End of Enrollment Budget Report Other-Data Elements

All Historical Document Collections

202404-0938-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-04-11
202302-0938-016 Approved without change	No material or nonsubstantive change to a currently approved collection	2023-03-10
202203-0938-011 Approved without change	Reinstatement with change of a previously approved collection	2022-04-12
201708-0938-014 Approved without change	Revision of a currently approved collection	2017-08-31
201504-0938-011 Approved without change	Revision of a currently approved collection	2015-04-24
201411-0938-005 Approved without change	Revision of a currently approved collection	2014-11-10
201308-0938-024 Approved without change	Revision of a currently approved collection	2013-08-23
201203-0938-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2012-03-21
201111-0938-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2011-11-22
201107-0938-018 Approved with change	Revision of a currently approved collection	2011-07-29
201101-0938-006 Approved with change	New collection (Request for a new OMB Control Number)	2011-01-18

OMB Details

Public - Progress Reports

Federal Enterprise Architecture: Health - Health Care Services

Form CMs-10371	Progress Report	Fillable Fileable	Form and instruction
Form CMS-10371	Progress Report	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.