OMB control number

Supporting Statement for Direct Enrollment Entities (CMS-10877)

OMB 0938-1463 · HHS/CMS.

OMB 0938-1463

This Information Collection Request (ICR) serves as the formal request for a new clearance associated with the Department of Health and Human Services (HHS) Program Integrity: Exchange, SHOP, and Eligibility Appeals Final Rule; and Notice of Benefit and Payment Parameters for 2018 Final Rule (2018 Payment Notice), 2020 Final Rule (2020 Payment Notice), 2022 Final Rule (2022 Payment Notice), 2023 Final Rule (2023 Payment Notice), and the 2025 Proposed Rule (2025 Payment Notice). This ICR details the burden associated with direct enrollment (DE) requirements that affect DE Entities (i.e., web-brokers and QHP issuers) as finalized in the 2020 Payment Notice covered under regulations in 45 C.F.R. §§ 155.205, 155.220, 155.221, and 156.1230; agreements between the Centers for Medicare & Medicaid Services (CMS) and DE Entities; and applicable program guidance issued by CMS; and 2022 and 2023 Payment Notices at 45 C.F.R. §§155.220 and 155.221. These DE requirements relate to Web-broker Operational Readiness Reviews (ORR); DE Entity ORR; Web-broker display of QHP comparative information and disclaimer; Web-broker rationale for QHP recommendations and methodology of QHP display; and required Disclaimers.

The latest form for Supporting Statement for Direct Enrollment Entities (CMS-10877) expires 2027-09-30 and is listed under ICR 202404-0938-015.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-10877 DE Entity Operational Readiness Review (ORR)	Form and Instruction
Form CMS-10877 Web-broker Operational Readiness Reviews (ORR)	Form and Instruction
CMS-10877 - Appendix_R_Direct_Enrollment_Entities_60-Day_Comment_Response_508.pdf	Supplementary Document
CMS-10877 Direct Enrollment Entities_Supporting Statementf.docx	Supporting Statement A
Web-brokers to Prominently Display Consumer Eligibility Results for Advance Payments of the Premium Tax Credit and Cost-sharing Reductions	Information collection
Application to State Exchanges	Information collection
Web-brokers to Implement Application to State Exchanges	Information collection
Direct Enrollment Entities to Implement Application Assister Requirements	Information collection
Web-Brokers to Provide the State Exchange a List of Agents or Brokers	Information collection
DE Entity Web-brokers and QHP Issuers to Implement Mandate for HealthCare.gov website Changes	Information collection
Issuers to Implement Website Display Requirements for QHPs	Information collection
Direct Enrollment Entities to Implement Third-Party Entity Contractual Requirements	Information collection
Direct Enrollment Entity Separate Plan Display Exception Requirement	Information collection
DE Entities to Implement Separate Plan Display Requirement	Information collection
Web-brokers to Implement the General non-FFE Disclaimer Requirement	Information collection
DE Entities to Implement the Standardized Disclaimer Requirement	Information collection
Web-broker Website Explanation of Rationale for QHP Recommendations and Methodology for Default Display	Information collection
Web-broker Website Required QHP Comparative Information and Enrollment Support Disclaimer	Information collection
DE Entity Operational Readiness Review (ORR)	Form and Instruction
Web-broker Operational Readiness Reviews (ORR)	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
202404-0938-015	New collection (Request for a new OMB Control Number)	2024-04-22		Approved with change
202311-0938-002	New collection (Request for a new OMB Control Number)	2023-12-05		Comment filed on proposed rule

OMB Details

Web-broker Operational Readiness Reviews (ORR)

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form CMS-10877	Security and Privacy Assessment Reports (SARs) template	Fillable Fileable	Form and instruction
Form CMS-10877	Web-Broker Agreement	Fillable Fileable	Form and instruction
Form CMS-10877	System Security and Privacy Plans (SSPs) workbook	Paper Only	Form and instruction
Form CMS-10877	Plans of Action and Milestones (POA&Ms) template	Fillable Fileable	Form and instruction

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