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 | Type |
|---|---|
 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All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201603-0938-018 | Revision of a currently approved collection | 2016-03-28 | Approved with change | |
| 201302-0938-002 | New collection (Request for a new OMB Control Number) | 2013-02-05 | Approved with change |