OMB control number

Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel - CAC (CMS-10494)

OMB 0938-1205 · HHS/CMS.

OMB 0938-1205

Section 1413 of the Affordable Care Act directs the Secretary of HHS to establish, subject to minimum requirements, a streamlined enrollment system for qualified health plans offered through the Exchange and insurance affordability programs. In addition, section 1321(a)(1) of the Affordable Care Act directs and authorizes the Secretary to issue regulations setting standards for meeting the requirements under title I of the Affordable Care Act, with respect to, among other things, the establishment and operation of Exchanges. Pursuant to this authority, regulations establishing the certified application counselor program are being finalized at 45 CFR 155.225. Specifically, 45 CFR 155.225(a) requires an Exchange to establish a certified application counselor program that complies with the requirements of the rule. Section155.225(b)(1) allows each Exchange to designate certain organizations, including organizations designated by state Medicaid or CHIP agencies, which will certify their staff and volunteers to act as certified application counselors. In accordance with 45 CFR 155.225(b)(2), Exchanges may choose to certify directly individuals who seek to act as certified application counselors, designate certain organizations which will certify staff or volunteers to perform application services, or do both.

The latest form for Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel - CAC (CMS-10494) expires 2021-01-31 and is listed under ICR 201703-0938-005.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-10494 Navigator Requirements for Training Certification	Form and Instruction
Form CMS-10494 Certified Counselor Designated Organization (CDO Application)	Form and Instruction
Form CMS-10494 Recertification request by organization	Form and Instruction
Form CMS-10494 155.225(b)(1) Organization designation by Exchange Information Updates	Form and Instruction
Form CMS-10494 155.225(d)(1) and (7) Training Quality Optional Questionnaire	Form and Instruction
Form CMS-10494 155.225(d)(1) - Training certificate retention	Form and Instruction
Form CMS-10494 155.225(d)(1) - Training certificate proof	Form and Instruction
Form CMS-10494 155.225(d)(1) - Training Registration	Form and Instruction
Form CMS-10494 155.225(b)(1)(ii) - Identification number record retention	Form and Instruction
Form CMS-10494 155.225(b)(1)(ii) - Issuance of unique registration identification number	Form and Instruction
Form CMS-10494 155.225(d)(2) and (f) (CAC authorization to consumer)	Form and Instruction
Form CMS-10494 155.225(b)(1)(i) (certificate issuance)	Form and Instruction
Form CMS-10494 155.225(b)(1) (organization follow-up for application)	Form and Instruction
Form CMS-10494 155.225(b)(1) (organization designation by Exchange)	Form and Instruction
CMS-10494 - Conflict of Interest Disclosure_ CAC).pdf	Supplementary Document
CMS-10494 - Non Substantive Change Request 508.pdf	Justification for No Material/Nonsubstantive Change
CMS-10494 - Supporting_Statement_March 2022.docx	Supporting Statement A
Navigator Requirements for Training Certification	Form and Instruction
Certified Counselor Designated Organization (CDO Application)	Form and Instruction
?155.225 (b)(ii) (performance tracking form by organization)	Information collection
?155.225 (b)(ii) (reporting performance data by certified application counselor)	Information collection
?155.225 (b)(ii) (recordkeeping performance data by organization)	Information collection
?155.225 (b)(1)(iii)- (reporting by organizations)	Information collection
?155.225 (b)(1)(iii)- (review by State Exchange)	Information collection
?155.225(b)(1)(iii)-(review byFederally-facilitatedExchange)	Information collection
Recertification Training	Information collection
Recertification request by organization	Form and Instruction
CAC Recertification	Information collection
155.225(b)(1) Organization designation by Exchange Information Updates	Form and Instruction
155.225(d)(1) and (7) Training Quality Optional Questionnaire	Form and Instruction
155.225(d)(1) - Training certificate retention	Form and Instruction
155.225(d)(1) - Training certificate proof	Form and Instruction
155.225(d)(1) - Training Registration	Form and Instruction
155.225(b)(1)(ii) - Identification number record retention	Form and Instruction
155.225(b)(1)(ii) - Issuance of unique registration identification number	Form and Instruction
155.225(d)(2) and (f) (CAC authorization to consumer)	Form and Instruction
155.225(d)(2) and (f) (organization record of authorization)	Information collection
155.225(b)(1)(i) (certificate issuance)	Form and Instruction
155.225(b)(1) (organization list)	Information collection
155.225(b)(1)(i) (organization attestation)	Information collection
155.225(b)(1) (organization follow-up for application)	Form and Instruction
155.225(b)(1) (organization designation by Exchange)	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202210-0938-013	No material or nonsubstantive change to a currently approved collection	2022-10-25	Approved without change
202110-0938-014	Revision of a currently approved collection	2021-11-03	Approved with change
201810-0938-013	Revision of a currently approved collection	2020-03-31
201703-0938-005	Revision of a currently approved collection	2017-03-13	Approved with change
201603-0938-001	Revision of a currently approved collection	2016-03-02	Comment filed on proposed rule and continue
201504-0938-012	Revision of a currently approved collection	2015-04-24	Approved without change
201407-0938-001	Revision of a currently approved collection	2014-07-03	Comment filed on proposed rule and continue
201308-0938-016	Revision of a currently approved collection	2013-08-15	Approved without change
201307-0938-015	New collection (Request for a new OMB Control Number)	2013-07-23	Approved with change

OMB Details

155.225(b)(1) (organization designation by Exchange)

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form CMS-10494	Individual CAC Agreement	Fillable Fileable	Form and instruction

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