Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Annual Report Removed 0 0 0 Form and Instruction CMS-10371 Annual Report Template
Form and Instruction CMS-10371 Annual Reporting Data Elements
End of Enrollment Budget Report Modified 18 185 0 Other-Data Elements
Quarterly Reports Removed 0 0 0 Form and Instruction CMS-10371 Quarterly Template
SBM Individual Market Reports (weekly) Modified 198 1931 0 Form and Instruction CMS-10371 SBM Individual Market Reporting
SBM Three-year Budget Reports Modified 21 336 0 Form and Instruction CMS-10371 SBM Three-Year Budget Template
Semi-Annual Reports Removed 0 0 0 Form and Instruction CMS-10371 Establishment Review - Semi-Annual
State Based Marketplace Data Collection Templates for Bi-Annual Reporting New 36 369 1251236 Other-Data Template
Total burden requested under this ICR: 273 2821 1251236  
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