Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
155.225(b)(1) (organization designation by Exchange) Modified 5000 5000 0 Form and Instruction CMS-10494
155.225(b)(1) (organization follow-up for application) Modified 1000 500 0 Form and Instruction CMS-10494
155.225(b)(1) (organization list) Modified 5000 1250 0
155.225(b)(1) Organization designation by Exchange Information Updates New 15000 3750 0 Form and Instruction CMS-10494
155.225(b)(1)(i) (certificate issuance) Modified 30000 480 0 Form and Instruction CMS-10494
Form and Instruction CMS-10494
Form and Instruction CMS-10494
155.225(b)(1)(i) (organization attestation) Modified 5000 1250 0
155.225(b)(1)(ii) - Identification number record retention Unchanged 30000 480 0 Form and Instruction CMS-10494
155.225(b)(1)(ii) - Issuance of unique registration identification number Modified 30000 900 0 Form and Instruction CMS-10494
155.225(d)(1) - Training Registration Unchanged 30000 900 0 Form and Instruction CMS-10494
155.225(d)(1) - Training certificate proof Modified 30000 1000 0 Form and Instruction CMS-10494
155.225(d)(1) - Training certificate retention Modified 30000 480 0 Form and Instruction CMS-10494
155.225(d)(1) and (7) Training Quality Optional Questionnaire New 30000 7500 0 Form and Instruction CMS-10494
155.225(d)(2) and (f) (CAC authorization to consumer) Modified 2200000 585200 0 Form and Instruction CMS-10494
Form and Instruction CMS-10494
Form and Instruction CMS-10494
155.225(d)(2) and (f) (organization record of authorization) Modified 2200000 70400 0
CAC Recertification New 18 1091 0
Recertification Training New 30000 1500 0
Recertification request by organization New 5000 12020 0 Form and Instruction CMS-10494
Total burden requested under this ICR: 4676018 693701 0  
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