OMB control number

Data Collection to Support Eligibility Determinations and Enrollment for Employees in the Small Business Health Options Program (CMS-10438)

OMB 0938-1194 · HHS/CMS.

OMB 0938-1194

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10438 SHOP - Employee Form and Instruction
CMS-10438 SHOP Employee Comment Chart 5-10-13.xlsx Supplementary Document
CMS-10438 SHOP Application_Employee_Supporting Statement_071816.docx Supporting Statement A
SHOP - Employee Form and Instruction

All Historical Document Collections

201603-0938-018 Approved with change	Revision of a currently approved collection	2016-03-28
201302-0938-002 Approved with change	New collection (Request for a new OMB Control Number)	2013-02-05