OMB control number
Student Health Insurance Coverage (CMS-10377)
OMB 0938-1157 ยท HHS/CMS.
OMB 0938-1157
Under the Student Health Insurance Final Rule, issuers of student health insurance are required to disclose to the student and any dependents in the insurance policy or certificate and any other written materials that the policy being issued does not meet all of the requirements under the Affordable Care Act.
The latest form for Student Health Insurance Coverage (CMS-10377) expires 2028-12-31 and is listed under ICR 202507-0938-004.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 CMS 10377 - Supporting Statement.pdf | Supporting Statement A |
| CMS 10377 - Supporting Statement.pdf | Supporting Statement A |
 Student Health Insurance Notice Requirement |
Information collection |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202507-0938-004 | Reinstatement without change of a previously approved collection | 2025-07-15 | ||
| 202204-0938-005 | Extension without change of a currently approved collection | 2022-04-15 | Approved without change | |
| 201907-0938-009 | Extension without change of a currently approved collection | 2019-07-30 | Approved without change | |
| 201903-0938-010 | Revision of a currently approved collection | 2019-03-26 | Withdrawn and continue | |
| 201606-0938-006 | Revision of a currently approved collection | 2016-06-22 | Approved without change | |
| 201309-0938-027 | New collection (Request for a new OMB Control Number) | 2013-09-26 | Approved with change | |
| 201111-0938-004 | New collection (Request for a new OMB Control Number) | 2011-11-08 | Comment filed on proposed rule |