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) Unchanged 1000 500 0 Form and Instruction CMS-10494
155.225(b)(1) (organization list) Unchanged 5000 1250 0
155.225(b)(1) Organization designation by Exchange Information Updates Unchanged 15000 3750 0 Form and Instruction CMS-10494
155.225(b)(1)(i) (certificate issuance) Unchanged 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) Unchanged 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 Unchanged 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 Unchanged 30000 1000 0 Form and Instruction CMS-10494
155.225(d)(1) - Training certificate retention Unchanged 30000 480 0 Form and Instruction CMS-10494
155.225(d)(1) and (7) Training Quality Optional Questionnaire Unchanged 60000 15000 0 Form and Instruction CMS-10494
155.225(d)(2) and (f) (CAC authorization to consumer) Unchanged 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) Unchanged 2200000 70400 0
CAC Recertification Modified 18 1091 0
Certified Counselor Designated Organization (CDO Application) Unchanged 7000 1225 0 Form and Instruction CMS-10494
Instruction
Navigator Requirements for Training Certification New 50 60977 0 Form and Instruction CMS-10494
Form CMS-10494
Recertification Training Unchanged 30000 1500 0
Recertification request by organization Unchanged 5000 12020 0 Form and Instruction CMS-10494
§155.225 (b)(1)(iii)- (reporting by organizations) Unchanged 20000 47500 0
§155.225 (b)(1)(iii)- (review by State Exchange) Unchanged 6000 1002 0
§155.225 (b)(ii) (performance tracking form by organization) Unchanged 5000 22500 0
§155.225 (b)(ii) (recordkeeping performance data by organization) Unchanged 80000 1280 0
§155.225 (b)(ii) (reporting performance data by certified application counselor) Unchanged 20000 80000 0
§155.225(b)(1)(iii)-(review byFederally-facilitatedExchange) Unchanged 14000 2338 0
Total burden requested under this ICR: 4858068 918023 0  
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