Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Application Modified 40 22560 28081 Form and Instruction CMS-10371 Revised FOA
Develpomental Phase Planning Review New 20 2220 0 Form and Instruction CMS-10371 Exchange Establishment Grant FOA
Operational Metrics - Monthly Reports New 96 2304 0 Form and Instruction CMS-10371 Exchange Establishment Grants FOA
Form and Instruction CMS-10371 Operational Metric – SBM Open Enrollment Weekly Indicators
Operational Metrics - Weekly Reports New 416 9984 0 Form and Instruction CMS-10371 Exchange Establishment Grant FOA
Form and Instruction CMS-10371 Operational Metric – SBM Open Enrollment Weekly Indicators
Outcome Metrics - Annual Report New 16 640 0 Form and Instruction CMS-10371 Outcome Metrics - Annual Report
Form and Instruction CMS-10371 Outcome Metric – SBM Exchange Metrics
Performance Reviews Modified 16 3760 0 Form and Instruction CMS-10371 Revised FOA
Periodic Reporting Modified 48 11280 0 Form and Instruction CMS-10371 Revised FOA
Public Modified 160 1360 0 Form and Instruction CMS-10371 Revised FOA
Semi-Annual Reports Modified 80 9712 0 Form and Instruction CMS-10371 Establishment Grant FOA
Start-Up Year Establishment Review New 32 2752 0 Other-Data Elements
Start-up Outcomes Metrics - Quarterly Reports New 64 1152 0 Form and Instruction CMS-10371 Start-up Outcomes Metrics - Quarterly Reports
Form and Instruction CMS-10371 Outcome Metric – SBM Exchange Metrics
Work Plan Update Modified 80 160 0 Form and Instruction CMS-10371 Revised FOA
Total burden requested under this ICR: 1068 67884 28081  
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