PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Application to State Exchanges
New
480
111320
7988733
DE Entities to Implement Separate Plan Display Requirement
New
40
800
64032
DE Entities to Implement the Standardized Disclaimer Requirement
New
100
700
53952
DE Entity Operational Readiness Review (ORR)
New
95
2689
200372
Form and Instruction
CMS-10877
Documentation and Audit Package
Form and Instruction
CMS-10877
Privacy Questiionaire
Instruction
Form and Instruction
CMS-10877
Application User Interface Toolkit
Form and Instruction
CMS-10877
Communications Toolkit
Form and Instruction
CMS-10877
Eligibility Results Toolkit
Form and Instruction
CMS-10877
Eligibility Results Toolkit - Phase 2
Form and Instruction
CMS-10877
Eligibility Results Toolkit - Phase 3
Form and Instruction
CMS-10877
Change Notification Form
Form and Instruction
CMS-10877
Business Agreement BY 2024
Form
CMS-10877
INTERCONNECTION SECURITY AGREEMENT
DE Entity Web-brokers and QHP Issuers to Implement Mandate for HealthCare.gov website Changes
New
125
3075
245290
Direct Enrollment Entities to Implement Application Assister Requirements
New
20
15000
1034100
Direct Enrollment Entities to Implement Third-Party Entity Contractual Requirements
New
25
500
37500
Direct Enrollment Entity Separate Plan Display Exception Requirement
New
20
400
32016
Issuers to Implement Website Display Requirements for QHPs
New
75
1500
120060
Web-Brokers to Provide the State Exchange a List of Agents or Brokers
New
1248
64896
117388
Web-broker Operational Readiness Reviews (ORR)
New
20
380
27786
Form and Instruction
CMS-10877
Web-Broker Agreement
Form and Instruction
CMS-10877
Security and Privacy Assessment Reports (SARs) template
Form and Instruction
CMS-10877
Plans of Action and Milestones (POA&Ms) template
Form and Instruction
CMS-10877
System Security and Privacy Plans (SSPs) workbook
Web-broker Website Explanation of Rationale for QHP Recommendations and Methodology for Default Display
New
20
100
8004
Web-broker Website Required QHP Comparative Information and Enrollment Support Disclaimer
New
20
500
40020
Web-brokers to Implement Application to State Exchanges
New
20
6100
473020
Web-brokers to Implement the General non-FFE Disclaimer Requirement
New
20
140
10790
Web-brokers to Prominently Display Consumer Eligibility Results for Advance Payments of the Premium Tax Credit and Cost-sharing Reductions
New
20
400
16008
Total burden requested under this ICR:
2348
208500
10469071
To view an IC, click on IC Title
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