OMB control number
State Health Insurance Exchange Security Incident Report
OMB 0938-1216 · HHS/CMS.
OMB 0938-1216
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10496 Incident Reporting | Form and Instruction |
| CMS-10496.Supporting Statement Part A.pdf | Supporting Statement A |
 Incident Reporting |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201403-0938-002 | Extension without change of a currently approved collection | 2014-03-06 | Approved without change | |
| 201308-0938-026 | New collection (Request for a new OMB Control Number) | 2013-08-27 | Approved without change |